The impact of meteorological factors on tuberculosis incidence in Spain: a spatiotemporal analysis.

Tuberculosis (TB) remains a global leading cause of death, necessitating an investigation into its unequal distribution. Sun exposure, linked to vitamin D (VD) synthesis, has been proposed as a protective factor. This study aimed to analyse TB rates in Spain over time and space and explore their relationship with sunlight exposure. An ecological study examined the associations between rainfall, sunshine hours, and TB incidence in Spain. Data from the National Epidemiological Surveillance Network (RENAVE in Spanish) and the Spanish Meteorological Agency (AEMET in Spanish) from 2012 to 2020 were utilized. Correlation and spatial regression analyses were conducted. Between 2012 and 2020, 43,419 non-imported TB cases were reported. A geographic pattern (north-south) and distinct seasonality (spring peaks and autumn troughs) were observed. Sunshine hours and rainfall displayed a strong negative correlation. Spatial regression and seasonal models identified a negative correlation between TB incidence and sunshine hours, with a four-month lag. A clear spatiotemporal association between TB incidence and sunshine hours emerged in Spain from 2012 to 2020. VD levels likely mediate this relationship, being influenced by sunlight exposure and TB development. Further research is warranted to elucidate the causal pathway and inform public health strategies for improved TB control.

Approaches to STI Prevention and Control in a Highly Decentralized State: An Integrative Review.

The Spanish health system is highly decentralized and Autonomous Regions (AR) are responsible for managing and implementing the National Strategic Plan for Prevention and Control of HIV and other Sexually Transmitted Infections (STI) (2013-2020) via autonomous plans adapted to the characteristics of each region. The aim of this study is to report on actions taken to specifically address STI prevention and control in the autonomous plans within the mainframe of the National Strategic Plan. An integrative review was performed to analyse the health plans and HIV/STI plans of the Spanish AR during the period of validity of the current National Strategic Plan; 2013-2020. Plans were selected attending to specificity and whether strategies were in force during the year 2020. Our gatherings show that plans are largely focused to HIV prevention and control and, to a lesser extent, to STI prevention. The analysis on pre-existing resources for care of STI varied by region, and epidemiological surveillance systems for STI notification were not completely adopted by all of them. Particularly noteworthy are information campaigns, pre- and post-exposure prophylaxis for HIV, and prevention activities in community settings. The remarkable lack of studies concerning STI resources and investment in Spain highlights the necessity of consensus-based tools for evaluation and future planning of STI prevention and control measures. The high degree of heterogeneity among plans for prevention of HIV infection and STIs also points out a high number of different areas for improvement in the development of new AR plans in HIV/STI.

Invasive Scedosporium and Lomentosora infections in the era of antifungal prophylaxis: A 20-year experience from a single centre in Spain.

BACKGROUND: Non-Aspergillus mould infections such as those caused by Scedosporium apiospermum or Lomentospora prolificans are an emerging threat. Few studies have monitored their long-term incidence. OBJECTIVES: To analyse the epidemiology, risk factors, clinical features and incidence of patients with proven and probable infections. PATIENTS/METHODS: Patients admitted to Gregorio Marañón Hospital between 1998 and 2017 and from whom Scedosporium/Lomentospora was isolated were studied. Subjects were classified as having a probable/proven invasive fungal infection or colonization. Molecular identification and antifungal susceptibility testing of isolates causing infection were performed, as well as a description of the patients and incidence of infection. RESULTS: One or more Scedosporium/Lomentospora isolates were identified in 67 patients. Sixteen (23.9%) patients had developed infection: 11 scedosporiosis and 5 lomentosporiosis. Stable incidence was observed throughout the study period. Most patients were immunosuppressed and the most common underlying diseases were haematologic malignancy (25%), solid organ transplantation (25%) and chronic corticoid therapy (25%). Breakthrough infection occurred in four patients, 2/11 (18.2%) cases of scedosporiosis and 2/5 (40%) of lomentosporiosis. Overall mortality was 54.5% (6/11) and 80% (4/5) in subjects with scedosporiosis and lomentosporiosis, respectively. High MICs of amphotericin B and remarkable inter-species susceptibility variability to triazoles was observed for most isolates. CONCLUSIONS: In contrast to previous studies, the incidence of scedosporiosis and lomentosporiosis has not increased at our hospital over the years. The tendency to cause disseminated infection and a reduced susceptibility to most antifungal agents leads to high mortality.