A case-control study to assess the effectiveness of pertussis vaccination during pregnancy on newborns, Valencian community, Spain, 1 March 2015 to 29 February 2016.

In the Valencian Community (Spain), the programme of maternal pertussis vaccination during pregnancy started in January 2015. The objective of this study was to estimate in this region the vaccine effectiveness (VE) in protecting newborns against laboratory-confirmed pertussis infection. A matched case-control study was undertaken in the period between 1 March 2015 and 29 February 2016. Twenty-two cases and 66 controls (+/- 15 days of age difference) were included in the study. Cases were non-vaccinated infants < 3 months of age at disease onset testing positive for pertussis by real-time PCR. For every case three unvaccinated controls were selected. Odds ratios (OR) were calculated by multiple conditional logistic regression for association between maternal vaccination and infant pertussis. Other children in the household, as well as mother- and environmental covariates were taken into account. The VE was calculated as 1 - OR. Mothers of five cases (23%) and of 41 controls (62%) were vaccinated during pregnancy. The adjusted VE was 90.9% (95% confidence interval (CI): 56.6 to 98.1). The only covariate in the final model was breastfeeding (protective effect). Our study provides evidence in favour of pertussis vaccination programmes for pregnant women in order to prevent whooping cough in infants aged less than 3 months.

Las enfermedades crónicas como prioridad de la vigilancia de la salud pública en España / Chronic diseases as a priority for the public health surveillance system in Spain

En la actualidad, la vigilancia epidemiológica sigue centrada, en España, en las enfermedades transmisibles incluidas en la lista de enfermedades de declaración obligatoria. Sin embargo, el patrón epidemiológico que dominó hasta las últimas décadas del siglo XX ha cambiado. Las enfermedades infecciosas, que eran las principales causas de morbimortalidad, han dado paso a un predominio de las enfermedades crónicas. En este sentido, se ha avanzado en la redacción y la aprobación de normativa específica sobre vigilancia de la salud pública. No obstante, tenemos pendiente el desarrollo de esta normativa que, entre otros puntos, recoge el mandato de organizar la vigilancia de las enfermedades no transmisibles en España. El objetivo de este trabajo es describir algunas características a tener en cuenta para desarrollar un sistema nacional de vigilancia de la salud pública vinculado a las estrategias ya existentes para la prevención y el control de las enfermedades crónicas (AU)

At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases (AU)

[Chronic diseases as a priority for the public health surveillance system in Spain]. / Las enfermedades crónicas como prioridad de la vigilancia de la salud pública en España.

At present, epidemiological surveillance in Spain remains focused on the communicable diseases included in the list of notifiable diseases. However, there has been a change in epidemiological pattern that predominated until the last few decades of the twentieth century. Infectious diseases, which used to be the leading causes of morbidity and mortality, have given way to a predominance of chronic diseases. In this regard, progress has been made in the drafting and adoption of specific legal regulations on public health monitoring. However, Spain has yet to develop this legislation which, among other elements, includes the mandate to organize the surveillance of non-communicable diseases in Spain. This article aims to describe some points that should be considered in the development of a national surveillance system linked to existing strategies for the prevention and control of chronic diseases.

[Invasive pneumococcal disease in the Community of Valencia. Six years of surveillance (2007-2012)]. / Enfermedad neumocócica invasiva en la Comunitat Valenciana. Seis años de vigilancia (2007-2012).

INTRODUCTION: The introduction of conjugated anti-pneumonia vaccines has led to a change in the epidemiology of Invasive Pneumococcal Disease (IPD). The aim of this study is to describe the trends in IPD in the Community of Valencia during the period 2007-2012. MATERIAL AND METHODS: A retrospective, descriptive and longitudinal study was conducted on IPD in the Community of Valencia during the period 2007-2012, The information sources used were the Epidemiological Surveillance Analysis (Análisis de la Vigilancia Epidemiológica (AVE)) and the Valencian Microbiology Network (Red Microbiológica Valenciana (RedMIVA)) of the Valencia Health Department. RESULTS: The incidence of IPD decreased between 2007 and 2012 in all age groups, mainly in the under 5 year-olds, dropping from 30.5 cases to 12.3 cases per 10(5) inhabitants (p< .001). Pneumonia was the principal presentation of the disease, with a decrease in its rates from 6.9 to 4.1 cases per 10(5) inhabitants (p< .001). A gradual, non-significant, reduction from 26% to 12% (p=.23) was observed in the proportion of cases due to the serotypes contained in the heptavalent vaccine (PCV7), mainly in the under 5 year-olds. The cases due to additional serotypes in 13-valent conjugated vaccine (1, 3, 5, 6A, 7F and 19A) also showed a decreasing trend, mainly in vaccinated under 5 year-olds (52.6% vs 14.3%; p=.03), while the cases due to non-vaccine serotypes significantly increased from 42.3% to 56.7% in the general population (p=.002), and from 47.4% to 78.6% in vaccinated under 5 year-olds (p=.08). CONCLUSIONS: The results of this study show a reduction in the incidence of IPD, with a decrease in the proportion of cases produced by vaccine serotypes, and an increase in the proportion of those not vaccinated. Epidemiological Surveillance is necessary to monitor the trends in the disease.

Genomic Investigation of a Legionellosis Outbreak in a Persistently Colonized Hotel.

OBJECTIVES: A long-lasting legionellosis outbreak was reported between November 2011 and July 2012 in a hotel in Calpe (Spain) affecting 44 patients including six deaths. Intensive epidemiological and microbiological investigations were performed in order to detect the reservoirs. METHODS: Clinical and environmental samples were tested for the presence and genetic characterization of Legionella pneumophila. Six of the isolates were subjected to whole-genome sequencing. RESULTS: Sequencing of 14 clinical and 260 environmental samples revealed sequence type (ST) 23 as the main responsible strain for the infections. This ST was found in the spa pool, from where it spread to other hotel public spaces, explaining the ST23 clinical cases, including guests who had not visited the spa. Uncultured clinical specimens showed profiles compatible with ST23, ST578, and mixed patterns. Profiles compatible with ST578 were obtained by direct sequencing from biofilm samples collected from the domestic water system, which provided evidence for the source of infection for non ST23 patients. Whole genome data from five ST23 strains and the identification of different STs and Legionella species showed that different hotel premises were likely colonized since the hotel opening thus explaining how different patients had been infected by distinct STs. CONCLUSIONS: Both epidemiological and molecular data are essential in the investigation of legionellosis outbreaks. Whole-genome sequencing data revealed significant intra-ST variability and allowed to make further inference on the short-term evolution of a local colonization of L. pneumophila.

Reemergencia del sarampión. Situación epidémica en la Comunidad Valenciana durante los años 2011 y 2012 / Reemergence of measles. Epidemic situation in the Valencian Community during the years 2011 and 2012

La incidencia del sarampión descendió hasta llegar a ser una notificación esporádica e infrecuente en la última década. La reemergencia de la enfermedad alcanzó 744 casos en 2012, tasa de 14,50 × 105habitantes.Se aplicó un diseño clásico en Vigilancia de Salud Pública: análisis retrospectivo de incidencia acumulada y características de los sujetos afectados. Se cruzaron los datos de encuesta con los de la Red Microbiológica Valenciana (RedMIVA).En total, 976 casos de sarampión fueron confirmados en el período epidémico 2011-2012. La distribución temporal muestra 3 ondas de amplitud constante: 12 a 15 semanas. La proporción de sujetos no vacunados y con estado vacunal desconocido alcanzó el 85% de los casos. Se documentaron 25 brotes, 499 casos asociados; en 7 de 10 brotes comunitarios, el inicio ocurrió en población de etnia gitana sin vacunar. En la ciudad de Valencia se aplicó profilaxis postexposición en 32 colegios, observándose bajas coberturas, entre el 63 y el 77%, en 8 centros e inferiores al 50% en 4. La tasa de serologías negativas fue del 12,4%, destacando los menores de 16 meses con el 44,8%. Las cohortes de 20 a 59 años presentaron tasas de negatividad del 13,5 al 5,9%.La epidemia tuvo su origen en la importación de casos a un territorio con insuficiente protección inmunitaria contra el sarampión. Su impacto y desarrollo estuvo condicionado por la cobertura vacunal previa, el patrón social y étnico de diferentes territorios y barrios, y la aplicación extensiva de profilaxis postexposición a contactos escolares y familiares de casos (AU)

Measles incidence declined until becomes a sporadic reporting and infrequent notification in the last decade. The reemergence of the disease reached 744 cases in 2012, a rate of 14.50 × 105 inhabitants. A classic design in Public Health Surveillance was performed: retrospective analysis of cumulative incidence and characteristics of the affected subjects. Those dates were in record linkage with Valencia Microbiology Network (RedMIVA).Finally, 976 cases of measles were confirmed in 2011-2012 epidemic period. Time-line distribution shows three waves with amplitude length on 12-15 weeks. Proportion of unvaccinated or unknown subjects came up to 85% of cases. 25 outbreaks were reported, 499 cases associated. In 7 of the 10 community outbreaks early cases were from Roma population unvaccinated. In the city of Valencia was applied post-exposure prophylaxis in 32 schools and was observed low coverage: between 63% and 77% in 8 schools and less than 50% in 4. Serum negative rate was 12.4% and we highlight the rate under 16 months: 44.8%. Cohorts of 20-59 years had negative rates between 13.5 to 5.9%.The origin of the epidemic was the importation of cases to a territory with inadequate immune protection against measles. Its impact and development was conditioned by previous immunization coverage, the social and ethnic pattern of different areas or quarters and the extensive application of post-exposure prophylaxis at school and family contacts of cases (AU)

Reemergencia del sarampión. Situación epidémica en la Comunidad Valenciana durante los años 2011 y 2012 / Reemergence of measles. Epidemic situation in the Valencian Community during the years 2011 and 2012

La incidencia del sarampión descendió hasta llegar a ser una notificación esporádica e infrecuente en la última década. La reemergencia de la enfermedad alcanzó 744 casos en 2012, tasa de 14,50 × 105 habitantes. Se aplicó un diseño clásico en Vigilancia de Salud Pública: análisis retrospectivo de incidencia acumulada y características de los sujetos afectados. Se cruzaron los datos de encuesta con los de la Red Microbiológica Valenciana (RedMIVA). En total, 976 casos de sarampión fueron confirmados en el período epidémico 2011-2012. La distribución temporal muestra 3 ondas de amplitud constante: 12 a 15 semanas. La proporción de sujetos no vacunados y con estado vacunal desconocido alcanzó el 85% de los casos. Se documentaron 25 brotes, 499 casos asociados; en 7 de 10 brotes comunitarios, el inicio ocurrió en población de etnia gitana sin vacunar. En la ciudad de Valencia se aplicó profilaxis postexposición en 32 colegios, observándose bajas coberturas, entre el 63 y el 77%, en 8 centros e inferiores al 50% en 4. La tasa de serologías negativas fue del 12,4%, destacando los menores de 16 meses con el 44,8%. Las cohortes de 20 a 59 años presentaron tasas de negatividad del 13,5 al 5,9%. La epidemia tuvo su origen en la importación de casos a un territorio con insuficiente protección inmunitaria contra el sarampión. Su impacto y desarrollo estuvo condicionado por la cobertura vacunal previa, el patrón social y étnico de diferentes territorios y barrios, y la aplicación extensiva de profilaxis postexposición a contactos escolares y familiares de casos

Measles incidence declined until becomes a sporadic reporting and infrequent notification in the last decade. The reemergence of the disease reached 744 cases in 2012, a rate of 14.50 × 105 inhabitants. A classic design in Public Health Surveillance was performed: retrospective analysis of cumulative incidence and characteristics of the affected subjects. Those dates were in record linkage with Valencia Microbiology Network (RedMIVA). Finally, 976 cases of measles were confirmed in 2011-2012 epidemic period. Time-line distribution shows three waves with amplitude length on 12-15 weeks. Proportion of unvaccinated or unknown subjects came up to 85% of cases. 25 outbreaks were reported, 499 cases associated. In 7 of the 10 community outbreaks early cases were from Roma population unvaccinated. In the city of Valencia was applied post-exposure prophylaxis in 32 schools and was observed low coverage: between 63% and 77% in 8 schools and less than 50% in 4. Serum negative rate was 12.4% and we highlight the rate under 16 months: 44.8%. Cohorts of 20- 59 years had negative rates between 13.5 to 5.9%. The origin of the epidemic was the importation of cases to a territory with inadequate immune protection against measles. Its impact and development was conditioned by previous immunization coverage, the social and ethnic pattern of different areas or quarters and the extensive application of post-exposure prophylaxis at school and family contacts of cases

Impacto de la inmigración desde Rumanía en la tuberculosis de un área mediterránea / No disponible

Fundamento: Conocer las características de la Tuberculosis en la provincia de Castellón y analizar los cambios que ha producido en ella la llegada de la inmigración procedente de Rumanía. Métodos: Estudio observacional retrospectivo de todos los casos declarados de Tuberculosis en los departamentos 2 y 3 de la Comunidad Valenciana entre los años 2004 y 2007.Resultados: Se estudiaron 306 casos, observando estabilización de casos en autóctonos y progresivo aumento en inmigrantes que en 2007 suponen el 47%, de los cuales el 64%procede de Rumanía. Los pacientes rumanos son más jóvenes (33,8 frente a 47,8 años), previamentesanos, con más proporción de mujeres (47% frente a 67%) y formas clínicas exclusivamente pleuropulmonares. Presentan elevado porcentaje de abandono de tratamiento (7,9%)y pérdidas del caso (15,8%). La tasa global de resistencias a tuberculostáticos en el total de casos ha sido del 4,5% y la de multirresistencia del 1,4%. Las resistencias en el grupo total de inmigrantes han sido del 5,15%: 1,6% en el grupo de inmigrantes rumanos y 11,4% en el grupo de inmigrantes de otras nacionalidades. Conclusiones: El fenómeno de la inmigración está modificando la dinámica de la Tuberculosis en Castellón. Se ha producido un freno en el declive de las tasas anuales de incidencia a expensas del aumento de casos en extranjeros, que en 2007 suponen el 47%, siendo en su mayoría de nacionalidad rumana (AU)

Aim: To know the characteristics of the Tuberculosis in the Castellón’s province and to analyze the changes that this has produced in because of the arrival of the immigration proceeding from Romania. Methods: Retrospective observacional study of all the declared cases of Tuberculosis in the department 2 and 3 of Castellón’s province between the year 2004 and 2007.Results: 306 cases were studied, observing stabilization of cases in autocthonous and progressive increase in immigrants who in 2007 represented 47 %, of which 64 % comes from Romania. The rumanian patients are younger (33,8 from to 47,8 years), previously healthy, with a higher women’s proportion (47% from 67%) and with clinical forms exclusively pleuropulmonars. They present a high percentage of treatment abandon (7,9%) and losses of the case(15,8%). The global rate of resistances to tuberculostáticos in the whole of cases has been 4,5%and of multirresistencia 1,4 %. In the complete group of immigrants, total resistance has been5,15%: 1,6% in the group of rumanian immigrants and 11,4% in the group of immigrants of other nationalities. Conclusions: The phenomenon of immigration is modifying the dynamics of Tuberculosis in Castellón. A brake has taken place in the decline of represented annual rates of TB mainly off the increase of cases in foreigners, who in 2007 suppose 47 %, being in the main of Rumanian nationality (AU)

[Pandemic influenza surveillance in the valencian community and seasonal influenza vaccines]. / Vigilancia de la gripe pandémica en la Comunidad Valenciana y vacuna antigripal estacional.

BACKGROUND: Surveillance of Pandemic influenza was carried out in the Valencian Community. Some effectiveness studies of the seasonal vaccine for AnH1N1 virus have presented no consistent results. The objective of the work consists on describing the results of the epidemic surveillance and effectiveness of the seasonal vaccine for pandemic influenza in the weeks 28 to 51, 2009. METHODS: We studied the cases in primary care, hospitalized confirmed, Polimerase Chain Reaction (PCR) and viral isolates and vaccine coverage. Vaccine effectiveness was calculated by the Farrington method of screening method, in three age groups, and two periods: vaccinated 2008-9 and 2009-10 seasons. RESULTS: In the first period (weeks 28-40) the incidence rates were highest in the group of 15-64 years (7207 cases), followed by those under 15 years (1596 cases). In the second period (weeks 45-47) children under 15 years (28218 cases) were the most affected. In both periods incidence in patients older than 65 years was low (rates of 56,3 and 125,1 respectively). In the studied period (weeks 28 at 51) 5481 cases were confirmed, of those that 1746 (31,8%) were hospitalized. The curve of hospitalization rate showed a profile similar to those in primary care and also in microbiological surveillance of the virus. The vaccine effectiveness in the second period was 25% in adults between 15 and 64 years and 51% in those older than 64 years. CONCLUSIONS: There is an age-dependent protection with positive vaccine efficacy in the elderly, although it may be confounded by natural exposure to the virus, previous immunizations or immune response.

[Real time information. A necessary tool in epidemiological surveillance]. / La información en tiempo real. Una herramienta necesaria en vigilancia epidemiológica.

Since 2004 an electronic epidemiological surveillance system (AVE) has been developed and implemented for infectious diseases in the autonomous region of Valencia that allows data collection from notifiable diseases in real time concerning outbreaks and alerts, as well as analysis and dissemination of the information. Within the autonomous region of Valencia, the system is used by 17 epidemiology units, which act as the first level of specialized surveillance. The electronic surveillance system is used by all these units, as well as by physicians working in primary and specialized care, who can introduce information from the ambulatory information system while the patient is in the practice room. The system is able to capture the demographic data from the patient and the physician can add any other information that is considered important for the case detected. The system receives new laboratory test results overnight from the Microbiological Surveillance Network (RedMIVA). AVE can record outbreaks of notifiable diseases as well as any unusual clusters or changing patterns of any disease. The department of epidemiology has access to the whole system for analysis of the information and for quality control of the epidemiological surveillance. The system provides timely and comprehensive information to facilitate public health action in individual cases of infectious disease.

[Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995-2003]. / Impacto de la inmigración en las resistencias de Mycobacterium tuberculosis en la provincia de Castellón: 1995-2003.

BACKGROUND AND OBJECTIVE: The aim of this study was to know the frequency of resistant Mycobacterium tuberculosis in the province of Castellon (Spain) and to determine whether immigration is associated with resistance. MATERIAL AND METHOD: All culture-positive cases diagnosed in Castellon from January 1995 to December 2003 were included in this retrospective study. Susceptibility tests were performed using the Canetti's proportion method and the MB/BacT system. Risk factors associated with tuberculosis were investigated in every case. RESULTS: Six hundred and forty-four cases of tuberculosis were studied: 560 were Spaniards and 84 foreigners. The overall frequency of resistant strains was 5%. The total rate of resistance in Spaniards was 3.7% and in foreigners 13.1%. In Spanish new cases, drug resistance was 3.2% and in foreigners new cases it was 13.9%. In previously treated cases, drug resistance was 6.7% in Spaniards and 0% in immigrants. No acquired drug resistance was detected in immigrants. Of those strains with resistance, 71.9% had resistance to only one drug, 18.7% to two drugs and 9.4% to more than two drugs. Multidrug-resistance was found in 9.4% of the resistant cases, and in 0.5% of all the studied population. The presence of resistant Mycobacterium tuberculosis was associated with the fact of having a foreign nationality (OR = 3.87; p < 0.001). CONCLUSIONS: Tuberculosis has been diminishing in Spanish patients in Castellon. Nevertheless, there is an important increase in the number of cases in foreigners, which is associated with a major percentage of resistances. Epidemiological vigilance efforts should especially concentrate on this group in order to support the progressive declivity of the disease.

Impacto de la inmigración en las resistencias de Mycobacterium tuberculosis en la provincia de Castellón: 1995-2003 / Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995-2003

Fundamento y objetivo: El objetivo del presente estudio es conocer la frecuencia de las resistencias de Mycobacterium tuberculosis en la provincia de Castellón y la influencia de la inmigración en su aparición. Material y método: Se ha realizado un estudio retrospectivo de todos los casos de tuberculosis con cultivo positivo diagnosticados en la provincia de Castellón entre enero de 1995 y diciembre de 2003 (9 años). El estudio de sensibilidad se ha llevado a cabo por el método de las proporciones de Canetti y por el sistema MB/BacT. Se ha investigado los factores de riesgo relacionados con la tuberculosis en cada uno de los casos. Resultados: Se ha estudiado 644 casos, 560 españoles y 84 extranjeros. Se ha detectado una tasa total de resistencia del 5%. En españoles, las resistencias totales han sido del 3,7% y en extranjeros, del 13,1%. En casos nuevos se ha encontrado un 3,2% de resistencias en españoles y un 13,9% en extranjeros, y en casos con tratamiento previo, un 6,7% en españoles y ninguno en inmigrantes. El 71,9% de las cepas con resistencia la tienen a 1 solo fármaco; el 18,7%, a 2, y el 9,4%, a más de 2. Los casos multirresistentes han supuesto un 9,4% de las resistencias y, con relación al total de la población estudiada, el 0,5%. De todas las variables analizadas, la única relacionada con la aparición de resistencias ha sido la nacionalidad extranjera (odds ratio [OR] = 3,87; p < 0,001). Conclusiones: La tuberculosis ha ido disminuyendo entre los pacientes españoles en la provincia de Castellón. Sin embargo, se aprecia un importante aumento del número de casos entre los extranjeros, que se ha relacionado con un mayor porcentaje de resistencias. Por todo ello, creemos que la vigilancia epidemiológica debe incidir especialmente en ese colectivo, a fin de mantener el progresivo declive de la enfermedad en nuestro medio

Background and objective: The aim of this study was to know the frequency of resistant Mycobacterium tuberculosis in the province of Castellon (Spain) and to determine whether immigration is associated with resistance. Material and method: All culture-positive cases diagnosed in Castellon from January 1995 to December 2003 were included in this retrospective study. Susceptibility tests were performed using the Canetti's proportion method and the MB/BacT system. Risk factors associated with tuberculosis were investigated in every case. Results: Six hundred and forty-four cases of tuberculosis were studied: 560 were Spaniards and 84 foreigners. The overall frequency of resistant strains was 5%. The total rate of resistance in Spaniards was 3.7% and in foreigners 13.1%. In Spanish new cases, drug resistance was 3.2% and in foreigners new cases it was 13.9%. In previously treated cases, drug resistance was 6.7% in Spaniards and 0% in immigrants. No acquired drug resistance was detected in immigrants. Of those strains with resistance, 71.9% had resistance to only one drug, 18.7% to two drugs and 9.4% to more than two drugs. Multidrug-resistance was found in 9.4% of the resistant cases, and in 0.5% of all the studied population. The presence of resistant Mycobacterium tuberculosis was associated with the fact of having a foreign nationality (OR = 3.87; p < 0.001). Conclusions: Tuberculosis has been diminishing in Spanish patients in Castellon. Nevertheless, there is an important increase in the number of cases in foreigners, which is associated with a major percentage of resistances. Epidemiological vigilance efforts should especially concentrate on this group in order to support the progressive declivity of the disease

[A study of whooping cough epidemic outbreak in Castellon, Spain]. / Estudio de un brote epidémico de tos ferina en Castellón.

BACKGROUND: Based on the report of several cases at one school, a study of an epidemic outbreak was started for the purpose of characterizing this outbreak from the person, place and time standpoint, calculating the effectiveness of the immunization and the concordance of the cases with the positive result of the serological study. METHODS: A "case" is defined as being that individual who has a cough fasting for two weeks. A study is made of the spread of the disease by means of the epidemic curve and the effectiveness of the pertussis vaccine. The concordance of the cases and the positive serology is evaluated by way of the Kappa index. RESULTS: From among the students at several schools and those with whom they were living at the time, a total of 130 individuals were surveyed, 94 of whom fit the "case" definition. The average age of the cases was 10.5 years of age, 42.6% being males and 84% school age children, 71.3% showing signs of recent infection (positive IgM), the average length of time since the last whooping cough immunization being 8.25 years. The effectiveness of the whooping cough booster is 66%. The concordance between the cases and the positive results of the serology reveals a Kappa = 0.45. No B. Pertussis was isolated in the 25 throat swab samples. CONCLUSIONS: Classrooms and the family environment are a factor in spreading this disease. The including of a booster at 18 months improves the effectiveness of the whooping cough immunization. The isolation of B. Pertussis is not very frequent, and the serology may be an alternative when this disease is clinically suspected.

Estudio de un brote epidémico de tos ferina en Castellón / A study of a whooping cough epidemic outbreak in Castellon, Spain

Fundamento: A partir de la declaración de varios casos en un centro escolar se inicia el estudio de brote con el objetivo de caracterizar éste desde el punto de vista de persona, lugar y tiempo; se calcula la efectividad de la vacuna, y se estudia la concordancia entre los casos y el resultado positivo del estudio serológico. Métodos: Se define caso a la persona que presenta tos persistente de dos semanas de duración. Se realiza estudio de la difusión de la enfermedad a través de la curva epidémica, y de la efectividad de la dosis de refuerzo de la vacuna antipertussis. La concordancia entre los casos y la serología positiva se evalúa por el índice Kappa. Resultados: Entre los alumnos de varios centros escolares y sus convivientes se encuesta a 130 personas, de los que 94 entran en la definición de caso. La media de edad de los casos es 10,5 años, un 42,6 per cent son varones, el 84 per cent escolares, el 71,3 per cent muestra signos de infección reciente (IgM positiva), y el tiempo medio desde la última dosis de vacuna antipertussis es de 8,25 años. La efectividad de la dosis de refuerzo de la vacuna es del 66 per cent. La concordancia entre los casos y el resultado positivo de la serología muestra un Kappa igual a 0,45. No se aisló B. Pertussis en las 25 muestras de frotis faríngeo. Conclusiones: Las aulas y el medio familiar son un factor de difusión de la enfermedad. La inclusión de una dosis de refuerzo a los 18 meses mejora la efectividad de la vacuna antipertussis. El aislamiento de la B. Pertussis es poco frecuente, y la serología, puede ser una alternativa ante la sospecha clínica de la enfermedad (AU)

[Nosocomial epidemic outbreak of acute gastroenteritis by Norwalk-like virus]. / Estudio de un brote epidémico nosocomial de gastroenteritis aguda por virus Norwalk-like.

BACKGROUND: From the notification of an acute gastroenteritis outbreak in a nursing home, an epidemiological study was started to determine the characteristics of the outbreak and its spreading pattern and to identify determining factors. PATIENTS AND METHOD: A study of historic cohorts was performed and the case was defined by the presence of diarrhea and vomiting. Spatial aggregation in double rooms was analyzed by a binomial distribution and temporal aggregation was analyzed by a relative risks model. The variables in the study allowed us to calculate the adjusted relative risk; the odds ratio was calculated in relation to the meal on day January 30. RESULTS: We studied 95.9% residents. The total attack rate was 28.7% (31.8% employees, 30.1% permanent residents and 15.2% day residents). The attack rate in rotation health personnel was 45.2%. Spatial and temporal spread in double rooms was negative. There was a significant association with the disease in rotator employees (RR = 3.22; CI 95%, 1.30-7.99; p = 0.02). No association was found between eating and disease (OR = 1.5; CI 95%, 0.4-6.1; p = 0.46). Norwalk-like virus was isolated in four faecal samples. CONCLUSIONS: This epidemic outbreak had the characteristic of a nosocomial infection with a likely person-to-person transmission mechanism. The main factor contributing to the spread of the infection was the existence of employees in permanent contact with residents with an important physical and mental impairment, hence highly dependent on the care provided by these health workers.

Estudio de un brote epidémico nosocomial de gastroenteritis aguda por virus Norwalk-like / Nosocomial epidemic outbreak of acute gastroenteritis by Norwalk-like virus

FUNDAMENTO: A partir de la declaración de un brote de gastroenteritis aguda en una residencia de ancianos (27 de enero-12 de febrero de 2001) se inició el estudio epidemiológico con el objetivo de caracterizar el brote, conocer la difusión de la enfermedad e identificar los factores que determinaron su aparición. PACIENTES Y MÉTODO: Se realizó un estudio de cohortes históricas, y se definió caso por la presencia de diarrea o vómitos. Se analizó la agregación espacial en habitaciones dobles por una distribución binomial, así como la agregación temporal por un modelo de riesgos relativos. Con las variables a estudio se calcula el riesgo relativo (RR) ajustado y con la comida del día 30 de enero, la odds ratio (OR). RESULTADOS: Se estudió al 95,9 por ciento de la población de la residencia, la tasa de ataque global fue del 28,7 por ciento (31,8 por ciento en trabajadores, 30,1 por ciento en internos y 15,2 por ciento en la residencia de día) y para los trabajadores sanitarios rotatorios, del 45,2 por ciento. La difusión espacial y temporal en las habitaciones dobles fue negativa. Se observó asociación significativa con la enfermedad en los trabajadores rotatorios (RR = 3,22; intervalo de confianza [IC] del 95 por ciento, 1,30-7,99; p = 0,02). No se observó asociación significativa entre la ingesta de alimentos y la enfermedad (OR = 1,5; IC del 95 por ciento, 0,4-6,1; p = 0,46). Se aisló virus Norwalk en 4 muestras de heces. CONCLUSIONES: Se trata de un brote epidémico que presenta las características de una infección nosocomial, cuyo mecanismo de transmisión más probable sería el contacto persona-persona, habiendo contribuido como factores determinantes la existencia de trabajadores en permanente contacto con personas con un gran deterioro físico y psíquico, y por tanto muy dependientes de los cuidados proporcionados por este personal. (AU)

[Mutations of resistance of HIV-1 in previously untreated patients at penitentiary centers of the Autonomous Community of Valencia, Spain. REPRICOVA study]. / Mutaciones de resistencia de virus de la inmunodeficiencia humana tipo 1 en pacientes no tratados de los centros penitenciarios de la Comunidad Valenciana. Estudio REPRICOVA.

BACKGROUND: Our purpose was to determine the prevalence of mutations of resistance to nucleoside inhibitors of reverse transcriptase (NIRT) and protease inhibitors (PI) in the HIV-1 genotype of naïve infected subjects in the prisons of the Autonomous Community of Valencia, Spain. PATIENTS AND METHOD: Multicentric, descriptive, cross-sectional study of prevalence including a systematic stratified and randomised sampling by centres. Demographic, clinical, virological and immunological data were collected. The HIV gene of protease and transcriptase was studied in peripheral blood plasma samples by means of double PCR amplification and subsequent automatic sequence. Reference: wild strain HXB2. RESULTS: Plasma was obtained from 133 individuals (119 men and 14 women). 117 samples were selected and the rest did not have enough copies for transcription. With regard to NIRT, 7 samples (5.2% of total) showed some mutation of resistance: M41L, D67N, L210W and K219Q, all them secondary to and associated with resistance to zidovudine, abacavir as well as group B multinucleoside-resistance. With regard to PI, only one sample showed a primary mutation, M46I, which was associated with resistance to indinavir. Moreover, a further 41 samples were found to express some secondary mutation. CONCLUSIONS: In our series, there was a low number of primary mutations of resistance. These results allow us to exclude the systematic use of resistance tests before an initiation antiretroviral therapy.