Public health response to an outbreak of SARS-CoV2 infection in a Barcelona prison.

An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.

[Control of SARS-CoV-2 in prisons]. / El control de la infección por SARS-CoV-2 en prisiones.

OBJECTIVE: Review of control and management of SARS-CoV-2 infection in penitentiary institutions in Spain and other countries. MATERIAL AND METHODS: A systematic review a comprehensive literature search in Global Health, SCOPUS, Medline and EMBASE was performed using relevant keywords and medical descriptors (MeSH) related to the coronavirus disease (COVID-19) and prisons. National and international recommendations and guides were examined as well as documents published by some countries. RESULTS: The key points of the guides are discussed. The vast majority of recommendations coincide with respect to the measures and procedures that should be used, except for some discrepancy regarding the population screening. Until now, most industrialized countries (except the US and some specific scenarios) have controlled successfully the epidemic in prisons. Less data is found as regards to socioeconomically more disadvantaged countries. CONCLUSIONS: Prisons are prone to a high risk of SARS-CoV-2 transmission due to their space limitations and sometimes poor environmental and hygienic conditions. The recommendations of the control and management of SARS-CoV-2 infection must be the same as those outside the prison, but must be adapted to the peculiarities of the prison. The recommendations must be issued by the health administration in coordination with the prison administration. Finally, must be abide by the Mandela Rules or by the Standard Minimum Rules for the treatment of United Nations prisoners.

Is it possible to eliminate hepatitis C from the prisons of Catalonia, Spain, in 2021?

AIM: Predict the elimination of chronic hepatitis C in Catalan prisons. MATERIAL AND METHOD: We analyzed the trend of the prevalence of HCV-RNA and anti-hepatitis C treatments prescribed in Catalonia in the period 2002-2016. Using linear exponential smoothing from the historical values in the time series, we estimate the time required to eliminate hepatitis C as a public health problem in prisons (prevalence of hepatitis C virus RNA<1%). RESULTS: A total of 1264 treatments were administered by 12/31/2016. The prevalence of hepatitis C virus RNA was 31.2% in 2002, decreasing to 8.81% in 2016. We estimate that prevalence will reach 0-0.5% in 5 years (second half 2021; 95% CI: 2019-2025). DISCUSSION: Appropriate actions can eliminate hepatitis C infection in prisoners. We estimate that by 2021 hepatitis C infection will no longer be a public health problem in Catalonia prisons.

Catalan contribution in the European project MEntally Disturbed Inmates Care and Support (MEDICS).

OBJECTIVE: To know the criteria of penitentiary professionals about the causes, management methods and improvement proposal, in the attention and care of inmates suffering non-serious mental disorders. MATERIAL AND METHODS: Activity developed from March to May 2015. In Catalonia, three prisons participated. Seven different models of anonymous and written questionnaires were distributed, designed by Italy, and aimed at directors, treatment teams, correctional officers, teachers, doctors, nursing staff and volunteers. They presented the degree of participation, descriptive characteristics of groups and main answers given. To study the association between qualitative variables, the Chi squared and the exact Fisher test was used. RESULTS: Questionnaires distributed among the 744 employees and there were obtained 174 filled (23.4%). There was more participation among health staff and treatment teams (88% and 36%). About the age of participants, doctors were the most senior group with meaningful differences (p <0.001). 40.7% were men and 57.7% women. Among the non-health staff 70% of correctional officers held a degree. Most of the total (62.4%) had their work as their main sources of knowledge about mental health. The main answers given are presented. DISCUSSION: Almost 25% of penitentiary professionals participated in the MEDICS project. Most of them (67%) held a degree. There is a professional concern about mental disorders but not discrimination. Some groups (doctors and, specially, non-health professionals) believe as basic a continuing training and working in multidisciplinary teams.

Hepatitis C virus reinfection among prisoners with sustained virological response after treatment for chronic hepatitis C.

BACKGROUND & AIMS: We estimated HCV reinfection rate and its associated risk factors in inmates with chronic hepatitis C who had achieved sustained virological response (SVR) after completing combination therapy while in prison. METHODS: Individuals who had achieved an SVR after treatment provided from January 2003 to December 2009 at four prisons in Catalonia, had been tested annually for HCV RNA and were in prison during 2010, were invited to complete a questionnaire regarding risk factors for reinfection. Incidence rate was calculated as 100 person-years of follow-up. Risk factors potentially associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression analysis. RESULTS: One hundred and nineteen subjects who had achieved an SVR agreed to participate. 98% were male, with a median age of 33.3 ± 6.3 years and 81% had a history of injection drug use (IDU). After a mean follow-up of 1.4 years, HCV reinfection was identified in nine former IDUs, seven with HCV genotype switch, for an overall reinfection rate of 5.27 cases per 100 person-years. Reinfection incidence was significantly higher among active drug users (HR=12.47; 95% CI: 2.90-53.71), HIV co-infected (HR=9.95; 95% CI: 1.73-57.34), and those engaging in more than one risk behaviors after treatment (HR=7.47; 95% CI: 1.19-46.89). CONCLUSIONS: HCV reinfection among inmates after successful treatment is high especially in those with ongoing IDU. Preventative interventions at diagnosis and during and after HCV treatment should be strongly reinforced.

A new species of Hypocristata (Nematoda, Trichostrongyuna, Heligmosomoidea) a parasite of Sigmodon hispidus (Cricetidae, Sigmodontinae) from Venezuela.

Description of Hypocristata tercera n. sp. (Heligmonellidae, Nippostrongylinae) a parasite of the small intestine of Sigmodon hispidus (Rodent, Sigmodontinae) from Venezuela. Two other species were described in the genus, both from Colombia and parasitic in Sigmodontinae. H. thomosomysi Durette-Desset, 1970, a parasite of Thomasomys sp. has about the same number of cuticular ridges at mid-body but differs by ridges having chitinoid struts, a caudal bursa pattern of type 2-2-1 (vs 1-3-1). H. anguillula Durette-Desset, 1970, a parasite of Sigmodontomys alfari (= Nectomys alfari) has the same caudal bursa pattern (type 1-3-1) but differs by the presence of ridges at mid-body in both sexes (absent at that level in H. tercera) and by ridges having chitinoid struts in female. This is the first report of the genus Hypocristata Durette-Desset, 1971 in Venezuela and in the genus Sigmodon (Sigmodontinae).

Recombinant Norwalk virus-like particles administered intranasally to mice induce systemic and mucosal (fecal and vaginal) immune responses.

Recombinant Norwalk virus-like particles (rNV VLPs) were administered to BALB/c mice by the intranasal (i.n.) route to evaluate the induction of mucosal antibody responses. The results were compared to systemic and mucosal responses observed in new and previous studies (J. M. Ball, M. E. Hardy, R. L. Atmar, M. E. Connor, and M. K. Estes, J. Virol. 72:1345-1353, 1998) after oral administration of rNV VLPs. Immunizations were given in the presence or absence of a mucosal adjuvant, mutant Escherichia coli heat-labile toxin LT(R192G). rNV-specific immunoglobulin G (IgG) and fecal IgA were evaluated by enzyme-linked immunosorbent assay. The i.n. delivery of rNV VLPs was more effective than the oral route at inducing serum IgG and fecal IgA responses to low doses of rNV particles. Vaginal responses of female mice given VLPs by the i.n. and oral routes were also examined. All mice that received two immunizations with low doses i.n. (10 or 25 microg) of rNV VLPs and the majority of mice that received two high doses orally (200 microg) in the absence of adjuvant had rNV-specific serum IgG, fecal, and vaginal responses. Additional experiments evaluated whether rNV VLPs can function as a mucosal adjuvant by evaluating the immune responses to two soluble proteins, keyhole limpet hemocyanin and chicken egg albumin. Under the conditions tested, rNV VLPs did not enhance the serum IgG or fecal IgA response to these soluble proteins when coadministered by the i.n. or oral route. Low doses of nonreplicating rNV VLPs are immunogenic when administered i.n. in the absence of adjuvant, and addition of adjuvant enhanced the magnitude and duration of these responses. Recombinant NV VLPs represent a candidate mucosal vaccine for NV infections in humans.

Estudio de la seroincidencia del VIH en población recluida en una prisión española a partir de determinaciones analíticas repetidas / A study of seroincidence of HIV amongst inmates in a spanish prison using repeated analytical determinations

Objetivo: Estimar la seroincidencia del VIH en la población recluida mediante determinaciones analíticas de repetición. Material y métodos: Estudio restrospectivo realizado en el C.P. de Quatre Camins con solicitudes analíticas de VIH realizadas en 1998-1999 que tuvieran previamente una determinación de resultado negativo. En los casos seroconvertidos, se analizan variables predictivas de seroconversión (SCV) efectuando análisis univariado y multivariado, mediante regresión de Poisson. Se calcula la razón de las tasas de incidencia (RR) y sus intervalos de confianza al 95 por ciento. Resultados: Se estudian 819 pacientes. Hubo 25 seroconversiones entre 1.348,88 personas año (pa) de seguimiento, con una tasa global de incidencia de 1,85 por 100 pa. Las variables predictivas de SCV fueron el uso de drogas por vía parenteral (mayor SCV en el grupo de UDVPs, p<0,001; RR= 1,31; IC: 1,18-1,46) y el grupo de edad de 25-34 años (mayor SCV en este grupo, p=0,004; RR= 1,20; IC: 1,06-1,35).Discusión: La determinación de la incidencia del VIH a partir de las analíticas que se practican rutinariamente en las prisiones es un método fácil, que no precisa de grandes recursos humanos ni añade nuevos costes económicos. Se propone sistematizar su uso, ya que ello permitiría evaluar periódicamente, y de forma aproximada pero fiable, las medidas preventivas aplicadas en la infección por el VIH, tanto penitenciaria como extrapenitenciariamente (AU)

Norwalk virus vaccines: challenges and progress.

Human caliciviruses (HuCVs) are the major cause of outbreaks of acute nonbacterial gastroenteritis throughout the world. An increasing recognition of the clinical significance of these viruses as human pathogens causing foodborne and waterborne disease indicates that an effective vaccine would be useful. This article reviews the current challenges that exist for the development of a vaccine for the HuCVs as well as the status of development of a candidate vaccine. HuCVs are viruses that exhibit a restricted tropism for infection of the gastrointestinal tract of humans, and a volunteer model of infection and disease is available. As pathogens with a restricted host range, the HuCVs are excellent models for understanding the mechanisms that mediate and regulate viral infection of the gastrointestinal tract and mucosal immunity in humans.

Predictors of tuberculosis transmission in prisons: an analysis using conventional and molecular methods.

OBJECTIVE: To determine the tuberculosis (TB) transmission patterns within the prison system in Catalonia, conventional epidemiological techniques were combined with DNA fingerprinting of Mycobacterium tuberculosis. METHODS: IS6110- and polymorphic GC-rich repeat sequence (PGRS)-based restriction fragment length polymorphism (RFLP) were combined with epidemiological studies to assess the relatedness of isolates from all patients with confirmed TB at five prisons in the province of Barcelona (Catalonia, Spain), between 1 July 1994 and 31 December 1996. Risk factors for transmission were analysed to a logistic regression. The extent of drug-resistant TB was also assessed. RESULTS: The incidence of TB during the study period was 2775 cases per 100,000 inmate years. Of the 247 culture-positive cases, 126 (51%) appeared to have active TB as a result of recent transmission. Using conventional epidemiological methods, 14 active chains of transmission were identified in prison involving 65 isolates (52% of clustered patients). A lengthy history of imprisonment [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.52-5.11] and pulmonary TB (OR 2.36, 95% CI 1.17-4.75) were independently associated with clustering. Low rates of both initial (2.9%) and acquired drug resistance (5.8%) were identified and there was no evidence of the transmission of drug-resistant TB. CONCLUSION: In the prison system studied, the recent transmission of TB contributes substantially to the overall incidence of the disease. Both lengthy incarcerations and delays in identifying inmates with pulmonary symptoms play a key role in this recent transmission. Directly observed therapy (DOT) is a critical control strategy for reducing the emergence of drug resistance and for avoiding the transmission of resistant organisms.

Recombinant Norwalk virus-like particles given orally to volunteers: phase I study.

BACKGROUND & AIMS: Norwalk virus (NV) is a major cause of epidemic gastroenteritis. The NV capsid is composed of a single protein that forms recombinant (rNV) virus-like particles (VLPs). In mice, these VLPs are immunogenic when administered orally without adjuvant, and they elicit serum immunoglobulin (Ig) G and intestinal IgA responses. The aim of this study was to evaluate the safety and immunogenicity of rNV VLPs in healthy volunteers. METHODS: Twenty antibody-positive adults were orally administered rNV VLPs in sterile Milli-Q water on days 1 and 21. Vaccine safety and serum rNV-specific total and subclass IgG and IgA antibody responses were monitored. The immune response induced by the VLPs was compared with the response elicited by replicating virus. RESULTS: No side effects were observed or reported by the volunteers. Serum IgG responses to rNV VLPs were dose-dependent, and all vaccinees given 250 microgram of rNV VLPs responded with >/=4-fold increases in serum IgG titers. Most of the volunteers (83%; 15 of 18) responded after the first rNV VLP dose and showed no increase in serum IgG titer after the second dose. CONCLUSIONS: Orally administered rNV VLPs are safe and immunogenic in healthy adults when administered without adjuvant and are useful to test the mucosal delivery of immunogens.

[Characteristics of AIDS cases detected at a prison in Barcelona (1991-1993)]. / Características de los casos de SIDA detectados en una prisión de Barcelona (1991-1993).

OBJECTIVE: To describe the cases of AIDS detected in a Barcelona prison. DESIGN: A prospective study. SETTING: A penitentiary for men in Barcelona. PATIENTS: All those inmates who had AIDS or were diagnosed with the illness during their stay in prison during the 36 months between 1/1/1991 and 31/12/93. RESULTS: 220 cases of AIDS (91.7% PVDA), 60% of which were diagnosed in prison. The PVDA were younger (p < 0.0001). There were a greater number of Spaniards among the UDVP (p < 0.01) and among those with tattoos (p < 0.001). The first manifestation of the disease in 53% of the cases was extrapulmonary Tuberculosis. CONCLUSIONS: Prisons are key places in the prevention and monitoring of HIV infection. The use of care programmes, including maintenance programmes using Methadone, for drug-dependent patients are recommended. The continuation of programmes tracking Tuberculosis, the main illness related to HIV infection in prison, is also recommended.