Post-exposure vaccine effectiveness and contact management in the mpox outbreak, Madrid, Spain, May to August 2022.

BackgroundAppropriate vaccination strategies have been key to controlling the outbreak of mpox outside endemic areas in 2022, yet few studies have provided information on mpox vaccine effectiveness (VE).AimTo assess VE after one dose of a third-generation smallpox vaccine against mpox when given as post-exposure prophylaxis (PEP) within 14 days.MethodsA survival analysis in a prospective cohort of close contacts of laboratory-confirmed mpox cases was conducted from the beginning of the outbreak in the region of Madrid in May 2022. The study included contacts of cases in this region diagnosed between 17 May and 15 August 2022. Follow up was up to 49 days. A multivariate proportional hazard model was used to evaluate VE in the presence of confounding and interaction.ResultsInformation was obtained from 484 close contacts, of which 230 were vaccinated within 14 days of exposure. Of the close contacts, 57 became ill during follow-up, eight vaccinated and 49 unvaccinated. The adjusted effectiveness of the vaccine was 88.8% (95% CI: 76.0-94.7). Among sexual contacts, VE was 93.6% (95% CI: 72.1-98.5) for non-cohabitants and 88.6% (95% CI: 66.1-96.2) for cohabitants.ConclusionPost-exposure prophylaxis of close contacts of mpox cases is an effective measure that can contribute to reducing the number of cases and eventually the symptoms of breakthrough infections. The continued use of PEP together with pre-exposure prophylaxis by vaccination and other population-targeted prevention measures are key factors in controlling an mpox outbreak.

First confirmation of importation and transmission in Spain of the newly identified SARS-CoV-2 B.1.1.7 variant.

INTRODUCTION: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. MATERIAL AND METHODS: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. RESULTS: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. CONCLUSION: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.

Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022.

Up to 22 June 2022, 508 confirmed cases of monkeypox (MPX) have been reported in the Madrid region of Spain, 99% are men (n = 503) with a median age of 35 years (range: 18-67). In this ongoing outbreak, 427 cases (84.1%) reported condomless sex or sex with multiple partners within the 21 days before onset of symptoms, who were predominantly men who have sex with men (MSM) (n = 397; 93%). Both the location of the rash, mainly in the anogenital and perineal area, as well as the presence of inguinal lymphadenopathy suggest that close physical contact during sexual activity played a key role in transmission. Several cases reported being at a sauna in the city of Madrid (n = 34) or a mass event held on the Spanish island of Gran Canaria (n = 27), activities which may represent a conducive environment for MPX virus spread, with many private parties also playing an important role. Because of the rapid implementation of MPX surveillance in Madrid, one of the largest outbreaks reported outside Africa was identified. To minimise transmission, we continue to actively work with LGBTIQ+ groups and associations, with the aim of raising awareness among people at risk and encouraging them to adopt preventive measures.

Prevalence and undiagnosed fraction of hepatitis C infection in 2018 in Spain: results from a national population-based survey.

BACKGROUND: A national strategy against hepatitis C virus (HCV) was implemented in Spain in 2015 with the aim of reducing associated morbidity and mortality. In order to improve our understanding of the epidemiology of HCV, we analysed the prevalence of HCV antibodies and active infection overall and by age and sex in the general population aged 20-80 years. We also aimed to report the undiagnosed fraction. METHODS: A national population-based seroprevalence survey was conducted in 2017-2018. A representative sample from the general population was selected using two-stage sampling. The prevalence of total HCV antibodies and of HCV RNA was calculated using inverse probability weighting based on bootstrapping. RESULTS: Overall, we approached 17 496 persons; 9103 agreed to participate and met the eligibility criteria and 7675 were aged 20-80. We obtained a prevalence of HCV antibodies of 0.85% [95% confidence interval (CI): 0.64-1.08%] and of active infection of 0.22% (95% CI: 0.12-0.32%). The prevalence of active HCV infection was highest in men aged 50-59 (0.86%; 95% CI: 0.28-1.57%) and in men aged 60-69 years (0.72%; 95% CI: 0.27-1.28%). Prevalence was below 0.20% in the remaining age groups. The undiagnosed fraction for active HCV infection was 29.4%. CONCLUSION: This study shows that prevalence of HCV in the general population in Spain is low and reflects the impact of scaling up treatment with direct acting antivirals, together with other prevention strategies, from 2015 onwards. The data reported can guide subsequent public health actions.

First confirmation of importation and transmission in Spain of the newly identified SARS-CoV-2 B.1.1.7 variant.

INTRODUCTION: A newly identified SARS-CoV-2 variant, VOC202012/01 originating lineage B.1.1.7, recently emerged in the United Kingdom. The rapid spread in the UK of this new variant has caused other countries to be vigilant. MATERIAL AND METHODS: We based our initial screening of B.1.1.7 on the dropout of the S gene signal in the TaqPath assay, caused by the 69/70 deletion. Subsequently, we confirmed the B.1.1.7 candidates by whole genome sequencing. RESULTS: We describe the first three imported cases of this variant from London to Madrid, subsequent post-arrival household transmission to three relatives, and the two first cases without epidemiological links to UK. One case required hospitalization. In all cases, drop-out of gene S was correctly associated to the B.1.1.7 variant, as all the corresponding sequences carried the 17 lineage-marker mutations. CONCLUSION: The first identifications of the SARS-CoV-2 B.1.1.7 variant in Spain indicate the role of independent introductions from the UK coexisting with post-arrival transmission in the community, since the early steps of this new variant in our country.

[Methodology of the 2nd seroprevalence study in Spain]. / Metodología del 2º estudio de seroprevalencia en España.

Seroprevalence studies are designed in population samples to assess the level and distribution of immunity induced by natural infection of certain infectious agents or by immunization against them. The purpose of the 2nd Seroprevalence Study in Spain is to assess the prevalence and distribution of immune status against vaccine-preventable diseases and generated by natural infection by other microorganisms. Pathologies specifically included in the study are: poliomyelitis, diphtheria, tetanus, pertussis, measles, rubella, mumps, varicella, invasive meningococcal disease by serogroup C, hepatitis A, hepatitis B, hepatitis E, hepatitis C and HIV. The study has a similar design of that conducted in 1996, as it is a descriptive cross-sectional study in resident population of 2 to 80 years of age in Spain. Two-stage conglomerate sampling was carried out on the population aged 2 to 80 years living in Spain, with an initial sample size of 10,000 people. The methodology of the study is described in this article.

Los estudios de seroprevalencia se elaboran en muestras poblacionales con el fin de investigar el nivel y distribución de la inmunidad inducida por infección natural de determinados agentes infecciosos o por vacunación frente a los mismos. El 2º Estudio de Seroprevalencia en España tiene el objetivo de estimar la prevalencia y distribución del estado inmune frente a las enfermedades inmunoprevenibles y de la generada por infección natural por otros microrganismos. En concreto, las patologías incluidas en el estudio son: poliomielitis, difteria, tétanos, tosferina, sarampión, rubéola, parotiditis, varicela, enfermedad meningocócica invasora por serogrupo C, hepatitis A, hepatitis B, hepatitis C, hepatitis E e infección por virus de la inmunodeficiencia humana (VIH). Para ello, se ha diseñado un estudio similar al realizado en 1996, observacional de tipo transversal en la población residente en España de 2 a 80 años de edad. Se ha realizado un muestreo por conglomerados bietápico de la población de 2 a 80 años residente en España, con un tamaño muestral inicial de 10.000 personas. En este artículo se describe la metodología utilizada en la realización del estudio.

Metodología del 2º estudio de seroprevalencia en España / Methodology of the 2nd seroprevalence study in Spain

Los estudios de seroprevalencia se realizan sobre una muestra de problación con el fin de investigar el nivel y distribución de la inmunidad inducida por infección natural de determinados agentes infecciosos o por vacunación frente a los mismos. El 2º Estudio de Seroprevalencia en España tiene el objetivo de estimar la prevalencia y distribución del estado inmune frente a las enfermedades inmunoprevenibles y de la generada por infección natural por otros microrganismos. En concreto, las patologías incluidas en el estudio son: poliomielitis, difteria, tétanos, tosferina, sarampión, rubéola, parotiditis, varicela, enfermedad meningocócica invasora por serogrupo C, hepatitis A, hepatitis B, hepatitis C, hepatitis E e infección por virus de la inmunodeficiencia humana (VIH). Para ello, se ha diseñado un estudio similar al realizado en 1996, observacional de tipo transversal en la población residente en España de 2 a 80 años de edad. Se ha realizado un muestreo por conglomerados bietápico de la población de 2 a 80 años residente en España, con un tamaño muestral inicial de 10.000 personas. En este artículo se describe la metodología utilizada en la realización del estudio

Seroprevalence studies are designed in population samples to assess the level and distribution of immunity induced by natural infection of certain infectious agents or by immunization against them. The purpose of the 2nd Seroprevalence Study in Spain is to assess the prevalence and distribution of immune status against vaccine-preventable diseases and generated by natural infection by other microorganisms. Pathologies specifically included in the study are: poliomyelitis, diphtheria, tetanus, pertussis, measles, rubella, mumps, varicella, invasive meningococcal disease by serogroup C, hepatitis A, hepatitis B, hepatitis E, hepatitis C and HIV. The study has a similar design of that conducted in1996, as it is a descriptive crosssectional study in resident population of 2 to 80 years of age in Spain. Two-stage conglomerate sampling was carried out on the population aged 2 to 80 years living in Spain, with an initial sample size of 10,000 people. The methodology of the study is described in this article

Descenso de la incidencia de la varicela en la Comunidad de Madrid tras la vacunación infantil universal. Años 2001-2015 / Decrease in the incidence of chickenpox in the Community of Madrid after universal childhood immunization. Years 2001-2015

Objetivo: La vacuna frente a la varicela se recomendó en la Comunidad de Madrid (CM) a los 15 meses de edad entre noviembre de 2006 y diciembre de 2013. El objetivo fue describir el impacto de la vacunación sobre la incidencia de la varicela en la CM durante el período 2001-2015. Diseño: Estudio descriptivo de los casos de varicela notificados a la Red de Médicos Centinela de la CM y de los casos registrados en el Conjunto Mínimo Básico de Datos al alta hospitalaria. Se calculó la incidencia de casos y de ingresos de varicela, total y específica por edad y sexo. Resultados: La incidencia fue un 94,0% menor en el período 2012-2013 que en el período 2001-2003. En el período 2014-2015 la incidencia fue un 61,8% superior que en el período 2012-2013. La incidencia más alta se apreció en los niños de 0-4 años excepto en el período 2010-2014, en el que fue superada por la del grupo de 5-9 años. La tendencia de los ingresos hospitalarios también fue decreciente, siendo el grupo de menores de un año el de mayor incidencia. Conclusiones: La recomendación de vacunar a los 15 meses de edad ha producido un importante descenso de la incidencia de casos y de ingresos por varicela en todos los grupos de edad, lo que es compatible con la efectividad de una dosis y su capacidad para producir inmunidad de grupo. La retirada de esta recomendación en 2014 y 2015 ha conllevado un incremento de la incidencia (AU)

Objective: Varicella vaccine was recommended in the Community of Madrid (CM) at 15 months of age between November 2006 and December 2013. The objective was to describe the impact of vaccination on the incidence of varicella in the CM during the period 2001-2015. Design: A descriptive study of cases of varicella reported to the Sentinel Physician Network of the CM and the cases recorded in the Minimum Basic Data Set at hospital discharge was carried out. Total incidence of cases and of hospital admissions were calculated, as well as specific incidence by age and sex. Results: The incidence was 94.0% lower between 2012 and 2013 than between 2001 and 2003. Between 2014 and 2015 the incidence was 61.8% higher than between 2012 and 2013. The highest incidence was observed in children aged 0 to 4 years except for 2010-2014, which was exceeded by the incidence in children aged 5 to 9. The trend in hospital admissions was also decreasing, with the highest incidence in children aged 0 to 1 year, followed by 1-4 years. Conclusions: There has been a significant decrease in the incidence of cases and of hospital admissions by varicella in all age groups after the recommendation to vaccinate at 15 months of age, which is compatible with the effectiveness of a dose and its ability to produce immunity group. The withdrawal of this recommendation between 2014 and 2015 has led to an increase in the incidence (AU)

[Decrease in the incidence of chickenpox in the Community of Madrid after universal childhood immunization. Years 2001-2015]. / Descenso de la incidencia de la varicela en la Comunidad de Madrid tras la vacunación infantil universal. Años 2001-2015.

OBJECTIVE: Varicella vaccine was recommended in the Community of Madrid (CM) at 15months of age between November 2006 and December 2013. The objective was to describe the impact of vaccination on the incidence of varicella in the CM during the period 2001-2015. DESIGN: A descriptive study of cases of varicella reported to the Sentinel Physician Network of the CM and the cases recorded in the Minimum Basic Data Set at hospital discharge was carried out. Total incidence of cases and of hospital admissions were calculated, as well as specific incidence by age and sex. RESULTS: The incidence was 94.0% lower between 2012 and 2013 than between 2001 and 2003. Between 2014 and 2015 the incidence was 61.8% higher than between 2012 and 2013. The highest incidence was observed in children aged 0 to 4years except for 2010-2014, which was exceeded by the incidence in children aged 5 to 9. The trend in hospital admissions was also decreasing, with the highest incidence in children aged 0 to 1year, followed by 1-4years. CONCLUSIONS: There has been a significant decrease in the incidence of cases and of hospital admissions by varicella in all age groups after the recommendation to vaccinate at 15months of age, which is compatible with the effectiveness of a dose and its ability to produce immunity group. The withdrawal of this recommendation between 2014 and 2015 has led to an increase in the incidence.

[Community outbreak of hepatitis A in a marginal population. Vaccination for its control and acceptance of the measure]. / Brote comunitario de hepatitis A en un poblado marginal. Vacunación para su control y aceptación de la medida.

OBJECTIVE: To study a community outbreak of hepatitis A in a marginal population and the public health response in order to bring it under control. DESIGN: Descriptive study of the outbreak that occurred in February-June, 2004. An epidemiological survey was conducted to detect prior cases and active vigilance was set up. Case and susceptibility definitions were established. SETTING: A gypsy population in Madrid, Spain. They had basic provision of sewerage, water supply and waste disposal. PARTICIPANTS: A population of 550 in census; estimated population, 800. 70% were under 40 and 55% were illiterate. INTERVENTIONS: Control measures were: a) health education activities to strengthen habits of hygiene, and b) immunisation of susceptible individuals. A total of 646 people were vaccinated, with the active help of staff from the Institute of Rehousing and Integration into Society. RESULTS: The outbreak affected 26 people, with an average age of 8 (95% CI, 6.2-9.8), similar distribution by sex and 3.3% attack rate. Fourteen cases were students at state schools, not all in the same classes. There were 7 pairs of siblings among the cases. The diagnosis was conformed by serology in 17 cases. Five needed hospital admission. CONCLUSIONS: The epidemic curve suggested person-person transmission. All those affected were under 20 years old. Vaccination was seen to be effective in controlling the outbreak. Interventions were assisted by intermediaries in order to respect the gypsies' cultural context and were well accepted.

Brote comunitario de hepatitis A en un poblado marginal. Vacunación para su control y aceptación de la medida / Community outbreak of hepatitis A in a marginal population. Vaccination for its control and acceptance of the measure

Objetivo. Estudio de un brote comunitario de hepatitis A en un poblado marginal y respuesta de salud pública para su control. Diseño. Estudio descriptivo del brote ocurrido entre febrero y junio de 2004. Se realizó una encuesta epidemiológica para detectar casos previos y se instauró una vigilancia activa. Se establecieron las definiciones de caso y de paciente susceptible. Emplazamiento. Poblado de etnia gitana en Madrid. Dispone de dotaciones básicas de saneamiento sanitario, abastecimiento de agua y eliminación de residuos. Participantes. Población censada, 550 personas; población estimada, 800 personas. El 70% es menor de 40 años y el 55% es analfabeto. Intervenciones. Las medidas de control fueron: a) actividades de educación sanitaria para reforzar los hábitos higiénicos, y b) inmunización de las personas susceptibles. Se vacunó a un total de 646 personas, con la colaboración activa del personal del Instituto de Realojo e Inserción Social. Resultados. El brote ha afectado a 26 personas, con una media de edad de 8 años (intervalo de confianza del 95%, 6,2-9,8), similar distribución según el sexo y con una tasa ataque del 3,3%. Catorce casos son alumnos de colegios públicos, sin agregación por aulas. Entre los casos había 7 parejas de hermanos. El diagnóstico se confirmó por serología en 17 casos. Cinco necesitaron hospitalización. Conclusiones. La curva epidémica señala una transmisión persona-persona. Todos los enfermos son menores de 20 años. La vacunación ha mostrado ser una medida eficaz en el control del brote. Las intervenciones se realizaron con la colaboración de mediadores para respetar su contexto cultural y fueron bien aceptadas

Objective. To study a community outbreak of hepatitis A in a marginal population and the public health response in order to bring it under control. Design. Descriptive study of the outbreak that occurred in February-June, 2004. An epidemiological survey was conducted to detect prior cases and active vigilance was set up. Case and susceptibility definitions were established. Setting. A gypsy population in Madrid, Spain. They had basic provision of sewerage, water supply and waste disposal. Participants. A population of 550 in census; estimated population, 800. 70% were under 40 and 55% were illiterate. Interventions. Control measures were: a) health education activities to strengthen habits of hygiene, and b) immunisation of susceptible individuals. A total of 646 people were vaccinated, with the active help of staff from the Institute of Rehousing and Integration into Society. Results. The outbreak affected 26 people, with an average age of 8 (95% CI, 6.2-9.8), similar distribution by sex and 3.3% attack rate. Fourteen cases were students at state schools, not all in the same classes. There were 7 pairs of siblings among the cases. The diagnosis was conformed by serology in 17 cases. Five needed hospital admission. Conclusions. The epidemic curve suggested person-person transmission. All those affected were under 20 years old. Vaccination was seen to be effective in controlling the outbreak. Interventions were assisted by intermediaries in order to respect the gypsies' cultural context and were well accepted

[Tuberculosis and immigration in a health sanitary area in Madrid, Spain. Trends in 1994-2003]. / Tuberculosis e inmigración en un área sanitaria de Madrid. Situación epidemiológica y evolución en la década 1994-2003.

BACKGROUND AND OBJECTIVE: To describe trends and epidemiological characteristics of immigrant and native populations with tuberculosis. POPULATION AND METHOD: Population-based, descriptive analysis of case data reported to the Regional Registry of Tuberculosis Cases from 1994 to 2003 living in the south of Madrid, Spain (755,202 inhabitants). RESULTS: The number of cases reported was 2211, of which 269 (12.1%) were foreign-born persons. Tuberculosis incidence declined from 46.6/100,000 in 1994 (2.9% immigrants) to 25.2/100,000 in 2003 (35.8% immigrants) (p < 0.001). Foreign-born persons with tuberculosis had come to Spain from Latin America-Caribbean (56%), Africa (30%) and Europe (11%). Of the foreign-born, 73.6% developed active tuberculosis within 5 years of arrival (50.9% within 2 years). CONCLUSIONS: The incidence of tuberculosis has declined in the study area but the tendency to decrease has come to a halt because of cases occurring among immigrants. Among those for whom the date of Spain entry was known, a half arrived 2 years or less prior to the diagnosis of tuberculosis. We stress that tuberculosis control programs must target such at-risk population.

Tuberculosis e inmigración en un área sanitaria de Madrid. Situación epidemiológica y evolución en la década 1994-2003 / Tuberculosis and immigration in a health sanitary area in Madrid, Spain. Trends in 1994-2003

Fundamento y objetivo: El objetivo de este estudio es cuantificar el aumento de tuberculosis importada y comparar las características clinicoepidemiológicas entre inmigrantes y autóctonos. Población y método: Estudio descriptivo poblacional de casos diagnosticados en Madrid (Área 11, 755.202 habitantes), en el período 1994-2003. La fuente de datos utilizada fue el Registro Regional de Casos de Tuberculosis. Resultados: Se notificaron 2.211 casos, 269 (12,1%) correspondían a inmigrantes. La tasa de incidencia pasó de 46,6/100.000 en 1994 (2,9% inmigrantes) a 25,2/100.000 en 2003 (35,8% inmigrantes) (p < 0,001). Los inmigrantes procedían de América Latina-Caribe (56%), África (30%) y Europa (11%). El 73,6% desarrolló tuberculosis en el primer quinquenio de estancia (un 50,9% en el primer bienio). Conclusiones: Se evidencia una tendencia decreciente en la incidencia global de tuberculosis, con disminución en la población autóctona y aumento en la población inmigrante. La mitad de los pacientes inmigrantes enferman en los 2 primeros años

Background and objective: To describe trends and epidemiological characteristics of immigrant and native populations with tuberculosis. Population and method: Population-based, descriptive analysis of case data reported to the Regional Registry of Tuberculosis Cases from 1994 to 2003 living in the south of Madrid, Spain (755,202 inhabitants). Results: The number of cases reported was 2211, of which 269 (12.1%) were foreign-born persons. Tuberculosis incidence declined from 46.6/100,000 in 1994 (2.9% immigrants) to 25.2/100,000 in 2003 (35.8% immigrants) (p < 0,001). Foreign-born persons with tuberculosis had come to Spain from Latin America-Caribbean (56%), Africa (30%) and Europe (11%). Of the foreign-born, 73.6% developed active tuberculosis within 5 years of arrival (50.9% within 2 years). Conclusions: The incidence of tuberculosis has declined in the study area but the tendency to decrease has come to a halt because of cases occurring among immigrants. Among those for whom the date of Spain entry was known, a half arrived 2 years or less prior to the diagnosis of tuberculosis. We stress that tuberculosis control programs must target such at-risk population

[Patterns of tuberculosis transmission in a health area of Madrid]. / Patrones de transmisión de la tuberculosis en un área sanitaria de Madrid.

BACKGROUND: Employing molecular epidemiology techniques for the study of tuberculosis can afford the possibility of identifying tuberculosis transmission patterns. This study has been made for the purpose of estimating the incidence of tuberculosis related to recent transmission in Madrid and of identifying the risk factors making it possible to define transmission patterns. METHODS: A three-year descriptive populational study was conducted on patients diagnosed with tuberculosis based on cultures in four districts in Madrid (550,442 inhabitants). The transmission patterns were described by means of conventional epidemiological research and molecular techniques (Restriction Fragment Length Polymorphism--RFLP--analysis with IS6110 and spoligotyping). RESULTS: An RFLP analysis was conducted on 233 clinically isolated Mycobacterium tuberculosis strains, 99 (42.5%) of which were grouped into 29 clusters. The most numerous group was comprised of 134 patients infected with M. tuberculosis strains of a single RFLP pattern. These patients averaged 48.3 years of age (DE 19.4), and 17.2% were revealed to have an endogenous risk factor. Two transmission patterns were identified among the grouped cases. The first pattern included 57 patients pertaining to 23 small clusters (2-4 cases), 25 (43.9%) of which were epidemiologically linked to another case from the same cluster. The second pattern was comprised of 42 patients grouped into 6 large clusters (5 cases or more). The subjects averaged 31.4 years of age (DE 15.8), 28.6% being intravenous drug users, 31% infected with HIV, and 26.2% having a prison background. CONCLUSIONS: Identifying tuberculosis transmission patterns by using molecular biology techniques affords the possibility of detecting population groups for whom preferential measures can be taken in the prevention and control programs.

Patrones de transmisión de la tuberculosis en un área sanitaria de Madrid / Patterns of tuberculosis transmission in a health area in Madrid, Spain

Fundamento: La aplicación de las técnicas de epidemiología molecular en el estudio de la tuberculosis puede permitir identificar los patrones de transmisión de la enfermedad. El objetivo de este estudio ha sido estimar la incidencia de tuberculosis asociada a transmisión reciente en Madrid e identificar los factores de riesgo que permitan definir patrones de transmisión. Métodos: Se realizó un estudio descriptivo poblacional de tres años de duración en pacientes diagnosticados de tuberculosis mediante cultivo en cuatro distritos de Madrid (550.442 habitantes).La descripción de los patrones de transmisión se realizó mediante la investigación epidemiológica convencional y las técnicas moleculares (análisis de fragmentos de restricción de longitud polimórfica -RFLP- con IS6110 y spoligotyping). Resultados: Se realizó RFLP en 233 aislados clínicos de Mycobacterium tuberculosis, de los que 99 (42,5 por ciento) estaban agrupados en 29 clusters. El grupo más numeroso lo formaban 134 enfermos infectados por cepas de M. tuberculosis con patrón RFLP único. Su media de edad era 48,3 años (DE 19,4) y el 17,2 por ciento presentaba un factor de riesgo de reactivación endógena. Entre los casos agrupados se identificaron dos patrones de transmisión. El primero de ellos incluía a 57 enfermos pertenecientes a 23 clusters pequeños (2-4 casos), de los que 25 (43,9 por ciento) estaban conectados epidemiológicamente con otro caso de su mismo cluster. El segundo lo formaban 42 pacientes agrupados en 6 clusters grandes (5 casos o más). La media de edad era de 31,4 años (DE 15,8), el 28,6 por ciento eran usuarios de drogas inyectadas, el 31 por ciento estaban infectados por el VIH, y el 26,2 por ciento tenían antecedentes de estancia en prisión. Conclusiones: La identificación de patrones de transmisión de la tuberculosis utilizando técnicas de biología molecular permite detectar grupos de población susceptibles de actuación preferente en los programas de prevención y control (AU)

Transmisión reciente de la tuberculosis en Madrid: utilidad de las técnicas moleculares / Recent transmission of tuberculosis in Madrid (Spain): usefulness of molecular techniques

Fundamento: En las zonas desfavorecidas de las grandes ciudades la incidencia de tuberculosis puede deberse en gran medida a la transmisión reciente de Mycobacterium tuberculosis. Pacientes y métodos: Estudio poblacional prospectivo de los pacientes diagnosticados de tuberculosis mediante cultivo en tres distritos urbanos de Madrid (población: 455.050 habitantes), en 1997 y 1998. Se cumplimentó un protocolo clinicoepidemiológico en todos los pacientes. Se incluyeron en agrupaciones los pacientes cuyos aislados tenían: a) idéntico patrón RFLP (fragmentos de restricción de longitud polimórfica) con 6 o más bandas de IS6110, o b) idéntico patrón RFLP con ó 5 bandas e idéntico patrón con la técnica de spoligotyping. Resultados: De los 207 pacientes con cultivo positivo para Mycobacterium tuberculosis se realizó RFLP a 148 (71,5 por ciento). Se identificaron 18 agrupaciones que incluían a 62 de los 148 pacientes (41,9 por ciento). Las agrupaciones contenían entre 2 y 12 casos. Los factores de riesgo asociados a la pertenencia a las distintas agrupaciones fueron la edad < 35 años (odds ratio [OR] = 4,1, intervalo de confianza [IC] del 95 por ciento: 1,9-8,9), el uso de drogas inyectadas (OR = 4,7, IC del 95 por ciento: 1,6-14,8), la infección por el VIH (OR = 2,7, IC: del 95 por ciento: 1,1-6,8) y la estancia previa en prisión (OR = 2,9, IC del 95 por ciento: 1,2-7,2). La investigación epidemiológica confirmó la transmisión reciente de la enfermedad en el 27 por ciento de los casos agrupados. Conclusiones: Una elevada proporción de los casos de tuberculosis diagnosticados en personas residentes en el sur de la ciudad de Madrid son resultado de transmisión reciente de la enfermedad. La investigación epidemiológica y molecular realizadas conjuntamente aportan información valiosa para el control de la enfermedad (AU)

Evolución de la enfermedad meningocócica en la Comunidad de Madrid. Efectividad de la vacunación antimeningocócica A+C / Evolution of meningococcal disease in the community of Madrid. Efficacy of A+C meningococcal vaccination

FUNDAMENTO: En el año 1997 (entre el 22 de septiembre y el 14 de noviembre) se efectuó una campaña de vacunación antimeningocócica A+C en la Comunidad de Madrid, en el grupo de edad de 18 meses a 19 años, ante el aumento del número de casos de enfermedad meningocócica por serogrupo C presentado en la temporada 1996-97. Este estudio forma parte de la evaluación de dicha campaña. MÉTODOS: Se ha valorado la evolución de la incidencia de la enfermedad meningocócica, mediante la comparación de tasas; y se ha determinado la efectividad de la vacunación al año (temporada 1997-98) y a los dos años (temporadas 1997-98 y 1998-99) de seguimiento. La efectividad vacunal se ha calculado como (1-(Tasa en vacunados/Tasa en no vacunados))*100. RESULTADOS: Se ha producido un descenso significativo en la incidencia de enfermedad meningocócica por serogrupo C al comparar las temporadas 1997-98 y 1998-99 con la temporada epidémica (1996-97). La efectividad vacunal a los dos años de seguimiento tras la campaña de vacunación ha sido de un 76,9 por ciento para la población global de 18 meses a 19 años y de un 88,5 por ciento en el grupo de vacunados entre 15 y 19 años. CONCLUSIONES: La efectividad vacunal obtenida es compatible con lo descrito en la literatura. La disminución significativa de la incidencia de enfermedad meningocócica por serogrupo C ha sido debida a la efectividad vacunal obtenida (AU)