[Impact of the pandemic on various infectious diseases with different epidemiological patterns of seasonality, transmission and age]. / Impacto de la pandemia en varias enfermedades infecciosas con patrones epidemiológicos distintos de estacionalidad, transmisión y edad.

OBJECTIVE: The COVID-19 pandemic has had a strong impact on other infectious diseases. The aim of this paper was to analyze the epidemiological changes that occurred during the pandemic in eight infectious diseases with different epidemiological patterns: influenza, respiratory syncytial virus, rotavirus, pneumococcus, Campylobacter, non-typhoid Salmonella, gonorrhea and herpes zoster. METHODS: From the Microbiological Surveillance Network, the time series of cases was traced from January 2017 to March 2023. Three periods were distinguished: reference, pandemic and beginning of the post-pandemic. The distribution by age and sex in these periods was analyzed. Incidence rates and rate ratios (RR) were calculated. These RRs and their 95% confidence intervals were estimated overall and by year of age in children under five years of age. RESULTS: Statistically significant differences were found in the impact that the pandemic had on each of these diseases. Some, after a period of epidemic silence, have revealed an intense post-pandemic rebound. The post-pandemic global RT increased for influenza (2.4), RSV (1.9) and gonorrhea (3.1); rotavirus recovered its pre-pandemic level (1.07); and pneumococcus (0.84), Campylobacter (0.83) and Salmonella (0.60) decreased. In children under 5 years of age, the patterns were specific and heterogeneous for each disease. CONCLUSIONS: The impact of the pandemic is very different in these diseases. Pediatric and respiratory-transmitted seasonal viral infections are the ones that are most affected, but with different patterns of recovery to normality. Gastrointestinal bacterial infections suffer fewer variations, except for rotavirus. Gonorrhea do not interrupt its increasing trend seen in the pre-pandemic. Shingles show a slight post-pandemic increase. Several diseases with different epidemiological patterns have been studied for a sufficient period to observe how the acute phase of the pandemic emerges.

OBJECTIVE: La pandemia de la COVID-19 ha tenido un fuerte impacto sobre otras enfermedades infecciosas. El objetivo de este trabajo fue analizar los cambios epidemiológicos acaecidos durante la pandemia en ocho enfermedades infecciosas con patrones epidemiológicos distintos: la gripe; virus respiratorio sincitial; rotavirus; neumococo; Campylobacter; Salmonella no tifoidea; gonococia; herpes zóster. METHODS: A partir de la Red de Vigilancia Microbiológica, se trazó la serie temporal de casos desde enero de 2017 a marzo de 2023. Se distinguieron tres periodos: prepandemia (referencia), pandemia e inicio de la pospandemia. Se analizó la distribución por edad y sexo en esos periodos. Se calcularon las tasas de incidencia y las razones de tasas (RT). Se estimaron esas RT globales y sus intervalos de confianza al 95% por cada año de edad en menores de cinco años. RESULTS: Se encontraron diferencias estadísticamente significativas en el impacto que la pandemia tuvo en cada una de esas enfermedades. Algunas, tras un periodo de silencio epidémico, revelaron un repunte intenso pospandémico. Incrementaron la RT global postpandémica la gripe (2,4), VRS (1,9) y gonococia (3,1); recuperó su nivel prepandémico el rotavirus (1,07); y disminuyeron el neumococo (0,84), Campylobacter (0,83) y Salmonella (0,60). En menores de cinco años, los patrones fueron específicos y heterogéneos para cada enfermedad. CONCLUSIONS: El impacto de la pandemia es muy diferente en estas enfermedades. Las infecciones víricas estacionales pediátricas y de transmisión respiratoria son las que más se ven afectadas, pero con patrones de recuperación de la normalidad distintos. Las infecciones bacterianas gastrointestinales sufren menos variaciones, salvo el rotavirus. La gonococia no interrumpe su tendencia al aumento avistada ya en la prepandemia. El herpes zóster muestra un ligero incremento pospandémico. Se han estudiado varias enfermedades con distinto patrón epidemiológico durante un periodo suficiente para observar cómo se produce la salida de la fase aguda de la pandemia.

Impacto de la pandemia en varias enfermedades infecciosas con patrones epidemiológicos distintos de estacionalidad, transmisión y edad / mpact of the pandemic on various infectious diseases with different epidemiological patterns of seasonality, transmission and age

Fundamentos: la pandemia de la covid-19 ha tenido un fuerte impacto sobre otras enfermedades infecciosas. El objetivo de este trabajo fue analizar los cambios epidemiológicos acaecidos durante la pandemia en ocho enfermedades infecciosas con patrones epidemiológicos distintos: la gripe; virus respiratorio sincitial; rotavirus; neumococo; campylobacter; salmonella no tifoidea; gonococia; herpes zóster.métodos: a partir de la red de vigilancia microbiológica, se trazó la serie temporal de casos desde enero de 2017 a marzo de 2023. Se distinguieron tres periodos: prepandemia (referencia), pandemia e inicio de la pospandemia. Se analizó la distribución por edad y sexo en esos periodos. Se calcularon las tasas de incidencia y las razones de tasas (rt). Se estimaron esas rt globales y sus intervalos de confianza al 95% por cada año de edad en menores de cinco años. Resultados: se encontraron diferencias estadísticamente significativas en el impacto que la pandemia tuvo en cada una de esas enfermedades. Algunas, tras un periodo de silencio epidémico, revelaron un repunte intenso pospandémico. Incrementaron la rt global postpandémica la gripe (2,4), vrs (1,9) y gonococia (3,1); recuperó su nivel prepandémico el rotavirus (1,07); y disminuyeron el neumococo (0,84), campylobacter (0,83) y salmonella (0,60). En menores de cinco años, los patrones fueron específicos y hete-rogéneos para cada enfermedad.conclusiones: el impacto de la pandemia es muy diferente en estas enfermedades. Las infecciones víricas estacionales pediá-tricas y de transmisión respiratoria son las que más se ven afectadas, pero con patrones de recuperación de la normalidad distintos. Las infecciones bacterianas gastrointestinales sufren menos variaciones, salvo el rotavirus. La gonococia no interrumpe su tendencia al aumento avistada ya en la prepandemia. El herpes zóster muestra un ligero incremento pospandémico. Se han estudiado varias enfermedades con distinto patrón epidemiológico durante un periodo suficiente para observar cómo se produce la salida de la fase aguda de la pandemia.(AU)

Background: the covid-19 pandemic has had a strong impact on other infectious diseases. The aim of this paper was to analyze the epidemiological changes that occurred during the pandemic in eight infectious diseases with different epidemiological patterns: influenza, respiratory syncytial virus, rotavirus, pneumococcus, campylobacter, non-typhoid salmonella, gonorrhea and herpes zoster.methods: from the microbiological surveillance network, the time series of cases was traced from january 2017 to march 2023. Three periods were distinguished: reference, pandemic and beginning of the post-pandemic. The distribution by age and sex in these periods was analyzed. Incidence rates and rate ratios (rr) were calculated. These rrs and their 95% confidence intervals were estimated overall and by year of age in children under five years of age. Results: statistically significant differences were found in the impact that the pandemic had on each of these diseases. Some, after a period of epidemic silence, have revealed an intense post-pandemic rebound. The post-pandemic global rt increased for influenza (2.4), rsv (1.9) and gonorrhea (3.1); rotavirus recovered its pre-pandemic level (1.07); and pneumococcus (0.84), campylobacter (0.83) and salmonella (0.60) decreased. In children under 5 years of age, the patterns were specific and heterogeneous for each disease.conclusions: the impact of the pandemic is very different in these diseases. Pediatric and respiratory-transmitted seasonal viral infections are the ones that are most affected, but with different patterns of recovery to normality. Gastrointestinal bacterial infections suffer fewer variations, except for rotavirus. Gonorrhea do not interrupt its increasing trend seen in the pre-pandemic. Shingles show a slight post-pandemic increase. Several diseases with different epidemiological patterns have been studied for a sufficient period to observe how the acute phase of the pandemic emerges.(AU)

Vitamin D status and latent tuberculosis infection: conversion in nursing homes, Spain.

OBJECTIVE: To examine the potential association between vitamin D (VitD) deficiency and latent tuberculosis infection (LTBI) and its effect on TB infection conversion (TBIC) incidence.MATERIAL AND METHODS: We carried out a cross-sectional and prospective cohort study of nine pulmonary TB cases that occurred in 2015-2016 in five nursing homes and one mental disability institution in Castellon, Spain. QuantiFERON®-TB Gold and the tuberculin skin test were used to detect LTBI and TBIC, respectively. Serum 25-hydroxyvitamin D was measured using chemiluminescence immunoassay. Poisson regression and inverse probability weighting were used for statistical analyses.RESULTS: The study included 448 residents, 341 staff members with 48 relatives of TB cases (participation rate 82%): of these, respectively 122 (27.2%), 37 (10.9%) and 7 (14.6%) were LTBI-positive; and respectively 22 (7.7%), 10 (3.8%) and 1 (3.7%) were TBIC-positive. LTBI was not associated with VitD status. Severe VitD deficiency (SVDD; defined as VitD level < 10 ng/ml), found in 45.1% of residents, as well as VitD levels of <30 ng/ml (aRR 10.41 95% CI 1.48-73.26), were associated with increased TBIC risk (adjusted relative risk [aRR] 12.1, 95% CI 1.51-97.10), suggesting SVDD as a threshold effect. CONCLUSION: Severe VitD deficiency is a TBIC risk factor.

Estimación de la incidencia de síndrome gripal durante la pandemia de gripe de 2009 / An estimate of the incidence of influenza-like illness during the influenza pandemic of 2009

Introducción: La pandemia de gripe de 2009 tuvo una gran repercusión social. Se dedicaron muchos recursos sanitarios a la atención médica, la prevención y la vigilancia epidemiológica. La vigilancia epidemiológica se sustenta en la notificación de casos de síndrome gripal y de casos confirmados de gripe. El objetivo fue la estimación de la incidencia real de síndrome gripal durante la pandemia de gripe de 2009. Métodos: Sistema de captura-recaptura durante el mes de mayor incidencia en Castellón. Se utilizaron 2 sistemas de información: a) sistema electrónico de notificación de enfermedades de declaración obligatoria (EDO), y b) datos de laboratorio (LAB). Las estimaciones se han realizado estratificando por grupo de edad y semana. Se calculó el coeficiente de independencia en estos estratos. Resultados: En total se identificaron 7.181 casos EDO y 524 LAB, de los que 211 coincidían en ambos sistemas. La estimación total fue de 17.785 casos en un mes. Ello significa que en el periodo estudiado casi el 4% de las personas del área sufrieron un cuadro gripal (incidencia acumulada), y aproximadamente una de cada 100 personas estuvo diariamente afectada (prevalencia diaria). Acudieron a consulta de atención primaria (EDO) un 40% de los afectados (sensibilidad del sistema EDO). Conclusiones: Para obtener una estimación de la incidencia real en la población durante la pandemia habría que multiplicar la cifra de consultas médicas por un factor de 2,5. Este factor es inferior al estimado en periodos sin alerta pandémica

Introduction: The influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009. Methods: The capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i) electronic reporting of Notifiable Diseases (ND), and (ii) laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata. Results: No dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care. Conclusions: To obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period,the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert

An estimate of the incidence of influenza-like illness during the influenza pandemic of 2009.

INTRODUCTION: The influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009. METHODS: The capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i)electronic reporting of Notifiable Diseases (ND), and (ii)laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata. RESULTS: No dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care. CONCLUSIONS: To obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period, the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert.

Rotavirus vaccination effectiveness: a case-case study in the EDICS project, Castellón (Spain).

In Spain, in 2006, two oral live-attenuated vaccines against rotavirus disease were licensed for infants up to 6 months. Recent data suggest that vaccine efficacy may vary by region. This makes the real-life postmarketing monitoring of rotavirus vaccination effectiveness an important aspect of rotavirus epidemiologic surveillance. We carried out a case-case study to assess the rotavirus vaccination effectiveness in children from 2 to 35 months of age during the year 2009 in Castellón. As a second- and counterfactual objective to evaluate the possible selection bias and the specificity of the association, we evaluated the "effectiveness" of pneumococcal vaccination against rotavirus diarrhea. Cases were 71 children with confirmed rotavirus gastroenteritis, and controls were 261 children with positive results to any other organism that was not rotavirus. The immunization status of each child, the number of doses and dates of vaccination were assessed by consulting the Regional Immunization Registry. The lowest proportion of vaccinated cases was observed among rotavirus diarrhea (2.8%). The proportion of vaccinated children among the control group was 21.8%. The effectiveness of vaccination with at least one dose of vaccine against rotavirus was 87.7% (45.5-99.7%). If we restrict the analysis to non-hospitalized children, this figure was slightly lower, 83.5% (25.4-96.3%). As expected, pneumococcal vaccination was not protective against rotavirus infection showing the specificity of the association found. The immunization information systems in combination with population-based studies of the incidence of infectious gastroenteritis, such as EDICS offer appropriate conditions for postmarketing monitoring of vaccine effectiveness.

Estudio retrospectivo de 10 años de la infección por rotavirus en la provincia de Castellón / Ten-year retrospective study of rotavirus infection in the province of Castellón (Spain)

Objetivo. El objetivo de este trabajo es conocer el porcentaje de la infección por rotavirus en niños menores de 14 años y su epidemiología en el área 02 de la provincia de Castellón. Material y métodos. Se realizó un estudio retrospectivo desde enero de 1995 hasta diciembre de 2004 en el que se analizaron 14.068 muestras de heces de pacientes pediátricos con gastroenteritis aguda. Las variables analizadas fueron: sexo, edad, procedencia, diagnóstico de rotavirus y fecha de diagnóstico. Se consideraron valores significativos p < 0,05. Resultados. El rotavirus fue detectado en el 11,9 % (1.687 casos) en los 10 años del estudio; el 12,14 % en varones y el 11,81 % en mujeres (p = 0,5459). La edad media de la población del estudio fue de 2,63 años. El grupo que presentó el mayor porcentaje de casos fue el de 1 a 4 años con el 14,1 % (p < 0,001) y pacientes ambulatorios con el 12,76 % (p < 0,05). En nuestra área, el rotavirus predomina significativamente (p < 0,001) en los meses de invierno. Conclusión. El rotavirus es una de las causas más importantes de morbilidad en la edad pediátrica en el hospital y en el ambulatorio. Afecta más frecuentemente a los niños menores de 4 años, y principalmente a los de 1 año. La infección se presentó de forma predominante en el invierno

Objective. To determine the percentage of rotavirus infection in children aged less than 14 years old and the epidemiology in area 02 of the province of Castellón (Spain). Material and methods. We performed a retrospective study from January 1995 to December 2004 in which 14,068 stool samples from pediatric patients with acute gastroenteritis were analyzed. The variables analyzed were sex, age, origin, diagnosis of rotavirus, and date of diagnosis. Differences were considered statistically significant if p < 0.05. Results. Rotavirus was detected in 11.9 % of the samples (1687 cases) in the 10 years of the study, 12.14 % corresponded to boys and 11.81 % to girls (p = 0.5459). The mean age of the population was 2.63 years. The highest percentage of cases occurred in the group aged 1- 4 years old (14.1 %; p < 0.001) and in outpatients (12.76 %; p < 0.05). In this geographical region, there was a significant tendency (p < 0.001) for rotavirus to occur in the winter months. Conclusion. Rotavirus is one of the main causes of morbidity in children both in the hospital and the outpatient setting. Children aged less than 4 years old are most frequently affected, especially those aged 1 year. The infection appears mainly in winter

[Risk factors for the occurrence of sporadic Campylobacter, Salmonella and rotavirus diarrhea in preschool children]. / Factores de riesgo de los casos esporádicos de diarrea por Campylobacter, Salmonella y rotavirus en niños preescolares.

BACKGROUND: Sporadic cases of diarrhea in preschool children are highly frequent, especially those caused by rotavirus, Campylobacter and Salmonella. The aim of this study was to identify some of the factors associated with these processes. MATERIAL AND METHODS: A case-control study of hospitalized incident cases aged less than 3 years old was performed. Questionnaires were administered at admission, before the results of stool tests were known. Susceptibility, food exposure, and environmental factors were investigated. Infants aged less than 1 year were analyzed separately. RESULTS: A total of 117 patients (rotavirus in 31, Campylobacter in 228 and Salmonella in 21, negative results in 37) and 84 controls were studied. Several protective factors, such as breast feeding and prior antibiotic use, were identified. Risk factors for diarrhea were exposure to meat products (eating or environmental exposure in the kitchen), some kinds of pets, and attendance at day care. Differences were found by etiology and age. In the culture-negative group, no risk factors were identified. CONCLUSION: The problems posed by epidemiological study of this issue are discussed. The main findings in each group of cases are interpreted and proposals are made for their application in the control and prevention of these diseases.

Factores de riesgo de los casos esporádicos de diarrea por Campylobacter, Salmonella y rotavirus en niños preescolares / Risk factors for the occurrence of sporadic Campylobacter, Salmonella and rotavirus diarrhea in preschool children

Antecedentes: Los casos esporádicos de diarrea en niños pequeños son muy frecuentes, sobre todo por rotavirus, Campylobacter y Salmonella. Se pretende identificar los factores asociados con estos procesos. Material y métodos: Estudio de casos y controles. Casos de diarrea hospitalizados menores de 3 años. Entrevista realizada inmediatamente al ingreso, antes de conocer el resultado del coprocultivo. Se investigaron factores de susceptibilidad, de alimentación y ambientales. Se ha distinguido en niños mayores y menores de 1 año. Resultados: Un total de 117 pacientes (rotavirus, 31; Campylobacter, 28; Salmonella, 21; negativos, 37) y 84 controles. Se identificaron varios factores protectores como lactancia materna y toma previa de antibiótico. Factores de riesgo relacionados como la exposición a productos cárnicos (por ingesta o ambiental en la cocina), a algunos animales domésticos o asistencia a guarderías. Hubo diferencias por tipo de germen y por grupo de edad. En el grupo de pacientes con el coprocultivo negativo no se identificaron factores de riesgo. Conclusión: Se discuten las dificultades que plantea el estudio epidemiológico de este tipo de casos. Se interpretan los hallazgos por grupos de microorganismos, por grupo de edad, y se plantea su aplicación en el control y prevención de estos procesos

Background: Sporadic cases of diarrhea in preschool children are highly frequent, especially those caused by rotavirus, Campylobacter and Salmonella. The aim of this study was to identify some of the factors associated with these processes. Material and methods: A case-control study of hospitalized incident cases aged less than 3 years old was performed. Questionnaires were administered at admission, before the results of stool tests were known. Susceptibility, food exposure, and environmental factors were investigated. Infants aged less than 1 year were analyzed separately. Results: A total of 117 patients (rotavirus in 31, Campylobacter in 228 and Salmonella in 21, negative results in 37) and 84 controls were studied. Several protective factors, such as breast feeding and prior antibiotic use, were identified. Risk factors for diarrhea were exposure to meat products (eating or environmental exposure in the kitchen), some kinds of pets, and attendance at day care. Differences were found by etiology and age. In the culture-negative group, no risk factors were identified. Conclusion: The problems posed by epidemiological study of this issue are discussed. The main findings in each group of cases are interpreted and proposals are made for their application in the control and prevention of these diseases

[Incidence of reactive arthritis and other musculoskeletal sequelae following a foodborne outbreak of Salmonella enteritidis phago type 14 b infection]. / Incidencia de artritis reactiva y síntomas osteoarticulares después de un brote de Salmonella enteritidis fagotipo 14 b.

BACKGROUND AND OBJECTIVE: We intended to estimate the prevalence of reactive arthritis (ReA) and other musculoskeletal sequelae after a foodborne outbreak of Salmonella enteritidis phago type 14 b in a banquet in Castellón in June 5th, 2004. PATIENTS AND METHOD: A prospective cohort study was carried out with 125 subjects (90.6%) out of the banquet participants. Sixty-two symptomatic infected cases occurred, 33 with positive cultures of S. enteritidis phago type 14 b, and 54 non-infected subjects. After 4 months of the outbreak, all 125 subjects were studied by means of a symptoms questionnaire of ReA based on Buxton et al, administered by telephone. Medical examination of subjects with musculoskeletal symptoms, 29 of 30, was done by a rheumatologist. Relative risk (RR) with 95% confidence interval (CI) was estimated by Poisson regression models. RESULTS: Any symptoms were reported by 32 (52%) of infected cases versus 13 (24%) of non-infected (RR adjusted = 2.49; 95% CI, 1.26-4.95); 20 (32%) infected cases reported muskuloskeletal symptoms compared to 4 (7%) non-infected (RR adjusted = 4.96; 95% CI, 1.64-15.04). The medical examination of the subjects with musculoskeletal symptoms revealed 3 infected cases with ReA (4.8%; 3/62). In addition, several reactive musculoskeletal sequelae associated with salmonellosis infection were found in 4 subjects (1 neck pain, 1 polyarthralgias, and 2 enthesopathy). CONCLUSIONS: The occurrence of ReA was lower than other studies but the incidence of musculoskeletal symptoms was increased. The infection by Salmonella supposes a risk for joint symptoms that could be important taking into account the high incidence of salmonellosis.

Incidencia de artritis reactiva y síntomas osteoarticulares después de un brote de Salmonella enteritidis fagotipo 14 b / Incidence of reactive arthritis and other musculoskeletal sequelae following a foodborne outbreak of Salmonella enteritidis phago type 14 b infection

Fundamento y objetivo: Estimar la incidencia de artritis reactiva (ARe) y otras secuelas osteoarticulares después de un brote de toxiinfección alimentaria causado por Salmonella enteritidis fagotipo 14 b en un banquete en Castellón el 5 de junio de 2004. Pacientes y método: Se efectuó un estudio de cohorte prospectivo con 125 personas (90,6% de los participantes al banquete). Hubo 62 casos clínicos o infectados, de los que 33 tenían un cultivo positivo a S. enteritidis fagotipo 14 b; 54 personas no resultaron infectadas. Cuatro meses después del brote, se llevó a cabo una encuesta telefónica en las 125 personas siguiendo el cuestionario de síntomas de ARe de Buxton et al1 mientras que un reumatólogo examinó a 29 de las 30 personas con síntomas osteoarticulares. Se estimó los riesgos relativos (RR) con un intervalo de confianza (IC) del 95% mediante modelos de regresión de Poisson. Resultados: Se detectó síntomas en 32 (52%) infectados frente a 13 (24%) de los no infectados (RR ajustado = 2,49; IC del 95%, 1,26-4,95); 20 (32%) de los infectados presentaron síntomas osteoarticulares frente a 4 (7%) de los no infectados (RR ajustado = 4,96; IC del 95%, 1,64-15,04). El examen médico de las personas con síntomas osteoarticulares halló 3 infectados con ARe (4,8%; 3/62). Además, se diagnosticó varias secuelas osteoarticulares reactivas asociadas a la salmonelosis en otros 4 infectados (1 cervicalgia, 1 poliartralgia y 2 entesopatías). Conclusiones: La incidencia de ARe fue más baja que en otros estudios pero la frecuencia de síntomas osteoarticulares fue alta. La infección por Salmonella supone un riesgo de síntomas osteoarticulares que pueden ser importantes considerando la elevada incidencia de la salmonelosis

Background and objective: We intended to estimate the prevalence of reactive arthritis (ReA) and other musculoskeletal sequelae after a foodborne outbreak of Salmonella enteritidis phago type 14 b in a banquet in Castellón in June 5th, 2004. Patients and method: A prospective cohort study was carried out with 125 subjects (90.6%) out of the banquet participants. Sixty-two symptomatic infected cases occurred, 33 with positive cultures of S. enteritidis phago type 14 b, and 54 non-infected subjects. After 4 months of the outbreak, all 125 subjects were studied by means of a symptoms questionnaire of ReA based on Buxton et al1, administered by telephone. Medical examination of subjects with musculoskeletal symptoms, 29 of 30, was done by a rheumatologist. Relative risk (RR) with 95% confidence interval (CI) was estimated by Poisson regression models. Results: Any symptoms were reported by 32 (52%) of infected cases versus 13 (24%) of non-infected (RR adjusted = 2.49; 95% CI, 1.26-4.95); 20 (32%) infected cases reported muskuloskeletal symptoms compared to 4 (7%) non-infected (RR adjusted = 4.96; 95% CI, 1.64-15.04). The medical examination of the subjects with musculoskeletal symptoms revealed 3 infected cases with ReA (4.8%; 3/62). In addition, several reactive musculoskeletal sequelae associated with salmonellosis infection were found in 4 subjects (1 neck pain, 1 polyarthralgias, and 2 enthesopathy). Conclusions: The occurrence of ReA was lower than other studies but the incidence of musculoskeletal symptoms was increased. The infection by Salmonella supposes a risk for joint symptoms that could be important taking into account the high incidence of salmonellosis

[Is the technique used to collect urine important in avoiding contamination of samples?]. / 'Es importante la técnica de recogida de la orina para evitar la contaminación de las muestras?

OBJECTIVE: To appraise the efficacy of hygienic standards in preventing the contamination of urine samples. DESIGN: Randomised clinical trial. 515 women assigned at random: 279 to the Intervention group and 236 to Control. SETTING: Population registered with 4 doctors at 2 health centres. PARTICIPANTS: Women from 15 to 65 who attended the clinic for on-demand care. Criteria for exclusion from the trial were: permanent bladder catheter, anomalies in genito-urinary apparatus, antibiotic treatment in the 7 previous days and inability to understand instructions. INTERVENTION: Verbal instructions on hygienic standards for collecting the sample and explanatory leaflet, as against the customary guidelines. MAIN MEASUREMENTS: The main result was the combination of contamination levels and infection. Analysis by intention to treat. RESULTS: Irregularities in the urine culture in 113 (41%) patients from the Intervention group and in 133 (56%) from the Control group (P<.001), with RRR of 28% (95% CI, 14%-40%) and NNT of 6 (95% CI, 4-14). Taking only serious contamination or urinary infection, we had 14 in the Intervention group and 36 in the Control (P<.0001), with RRR of 67% (95% CI, 41%-82%) and NNT of 10 (95% CI, 6-20). CONCLUSIONS: Providing an explanatory leaflet and giving verbal instructions on hygienic standards for urine collection reduces contamination of the samples.

Lesión cutánea foruncular en un viajero procedente de un país sudamericano / Furuncular skin lesion in a traveler coming from a South American country

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