Primera onda pandémica de COVID-19 en Navarra, febrero-junio 2020 / First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020

Fundamento. En 2020 se declaró la pandemia de COVID-19. La escasez de pruebas diagnósticas limitó la monitorización de la primera onda pandémica. El objetivo fue estimar y describir esta onda en Navarra (España). Métodos. La primera onda pandémica en Navarra, desde febrero a junio de 2020, se caracterizó a partir de la vigilancia epidemiológica reforzada, de la encuesta seroepidemiológica nacional y del registro de mortalidad. Resultados. Se confirmaron 10.358 personas con COVID-19 (1,6 % de la población), 1.943 requirieron ingreso hospitalario (3 por 1.000 habitantes), 139 ingresaron en UCI (21 por 100.000) y 529 fallecieron (80 por 100.000). La mortalidad aumentó exponencialmente con la edad, superando el 1 % en mayores de 85 años. El 58 % de las defunciones ocurrieron en residentes en centros socio-sanitarios. El registro de mortalidad recibió notificación de 733 muertes por COVID-19 confirmado o probable, mientras que el exceso de mortalidad fue de 613 defunciones (20,9 %) concentradas entre mediados de marzo y finales de abril. Al final de la onda, se estima que el 6,7 % (n = 44.000) de la población tenía anticuerpos detectables frente al SARS-CoV-2 y el 10,3 % había pasado la infección. La incidencia de infección estimada aumentó abruptamente en la primera quincena de marzo y descendió rápidamente durante el confinamiento domiciliario en la segunda quincena de marzo. Conclusiones. La primera onda pandémica produjo un número enorme de casos, hospitalizaciones y defunciones en Navarra en pocas semanas. El marcado descenso de los contagios durante el confinamiento domiciliario sugiere una eficacia y un impacto considerables de esta medida en la contención de la transmisión.(AU)

Background. The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). Methods. Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. Results. A total of 10,358 persons (1.6 % of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1 % in people over 85 years. 58 % of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9 %) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7 % (n = 44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3 % had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. Conclusions. The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.(AU)

[First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020].

BACKGROUND: The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain). METHODS: Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre. RESULTS: A total of 10,358 persons (1.6?% of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1?% in people over 85 years. 58?% of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9?%) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7?% (n?=?44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3?% had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March. CONCLUSIONS: The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.

Características y métodos estadísticos empleados en los artículos originales publicados en las revistas de Salud Pública en España / Characteristics and statistical methods used in original articles published in Public Health journals in Spain

Fundamento: Describir las características y métodos estadísticos utilizados en los artículos originales publicados en Gaceta Sanitaria, Revista Española de Salud Pública y Anales del Sistema Sanitario de Navarra, revistas españolas de Salud Publica indexadas en el JRC de 2016. Métodos: Se revisaron todos los artículos publicados en dichas revistas durante 2007, 2012 y 2017. Para cada artículo se registraron sus características generales (ano, revista, idioma, área temática) y metodológicas (diseño estadistico, propósito, método, programas). Resultados: Se revisaron 310 artículos, 73% de ellos estudios transversales. Las áreas mas frecuentes fueron Evaluación y servicios sanitarios (24%) y enfermedades cronicas (21%). A lo largo del periodo 2007-2017 se observo un aumento de articulos en ingles (4 vs 20%, p<0,001) y de mujeres como autoras principales (46 vs 62%, p=0,028) o senior (27 vs 36%, p=0,029). No se detectaron cambios significativos según los tipos de análisis (p=0,933). Conclusiones: Las características y métodos estadísticos utilizados en las publicaciones científicas no se han visto modificadas en los últimos anos. Sin embargo, aumentan las publicaciones en inglés y las mujeres están tomando un papel más relevante en la autoria

Background: To describe the characteristics and statistical methods used in the original articles published in Gaceta Sanitaria, Revista Española de Salud Pública y Anales del Sistema Sanitario de Navarra, the Spanish public health journals in Spain indexed in the 2016 JRC. Methods: All articles published in these journals in 2007, 2012 and 2017 were reviewed. For each article, general aspects (year, journal, language, area) and statistical characteristics (design, purpose, method and software) were recorded. Results: A total of 310 articles were reviewed, 73% of them were cross-sectional studies. Evaluation and health services (24%) and chronic diseases were the most frequent areas. During the 2007-2017 period there was an increase in both the number of works written in English (4 vs 20%, p<0.001) and by women as the main (46 vs 62%, p=0.028) or senior authors (27 vs 36%, p=0.029). Significant changes concerning type of analysis were not detected (p=0.933). Conclusions: The characteristics and statistical methods used in scientific publications have not been modified in recent years. However, publications written in English have increased and women are playing a more relevant role in authorship

[Characteristics and statistical methods used in original articles published in Public Health journals in Spain]. / Características y métodos estadísticos empleados en los artículos originales publicados en las revistas de Salud Pública en España.

BACKGROUND: To describe the characteristics and statistical methods used in the original articles published in Gaceta Sanitaria, Revista Española de Salud Pública y Anales del Sistema Sanitario de Navarra, the Spanish public health journals in Spain indexed in the 2016 JRC. METHODS: All articles published in these journals in 2007, 2012 and 2017 were reviewed. For each article, general aspects (year, journal, language, area) and statistical characteristics (design, purpose, method and software) were recorded. RESULTS: A total of 310 articles were reviewed, 73% of them were cross-sectional studies. Evaluation and health services (24%) and chronic diseases were the most frequent areas. During the 2007-2017 period there was an increase in both the number of works written in English (4 vs 20%, p<0.001) and by women as the main (46 vs 62%, p=0.028) or senior authors (27 vs 36%, p=0.029). Significant changes concerning type of analysis were not detected (p=0.933). CONCLUSIONS: The characteristics and statistical methods used in scientific publications have not been modified in recent years. However, publications written in English have increased and women are playing a more relevant role in authorship. KEYWORDS: Authorship. Statistical Analysis. Scientific research. Public Health. Spain.

Cause of death in hospitalized patients with laboratory-confirmed influenza.

BACKGROUND: We analyzed the underlying cause of death recorded in hospitalized patients with laboratory-confirmed influenza. METHODS: The present study included all patients with a laboratory-confirmed diagnosis of influenza during the influenza seasons 2009-2010 to 2013-2014 who were attended to in hospital and died. Their underlying cause of death according to the International Classification of Diseases 10th Revision was obtained from the Navarre Mortality Registry. RESULTS: Among 49 patients studied, the underlying causes of death were 35% influenza, 4% pneumonia, 14% other respiratory diseases, 10% circulatory disease and 37% other causes. CONCLUSIONS: Non-cardiorespiratory causes accounted for a third of deaths in patients with confirmed influenza, thus all-cause mortality should be considered in estimating the full burden of influenza mortality.

Cause of death in hospitalized patients with laboratory-confirmed influenza / Causa de muerte en pacientes hospitalizados con gripe confirmada por laboratorio

Background: We analyzed the underlying cause of death recorded in hospitalized patients with laboratory-confirmed influenza. Methods: The present study included all patients with a laboratory-confirmed diagnosis of influenza during the influenza seasons 2009-2010 to 2013-2014 who were attended to in hospital and died. Their underlying cause of death according to the International Classification of Diseases 10th Revision was obtained from the Navarre Mortality Registry. Results: Among 49 patients studied, the underlying causes of death were 35% influenza, 4% pneumonia, 14% other respiratory diseases, 10% circulatory disease and 37% other causes. Conclusions: Non-cardiorespiratory causes accounted for a third of deaths in patients with confirmed influenza, thus all-cause mortality should be considered in estimating the full burden of influenza mortality (AU)

Fundamento: La mortalidad por gripe no se conoce bien porque la mayoría de las personas que mueren por gripe no se confirman por laboratorio. Analizamos la causa básica de muerte registrada en los pacientes hospitalizados con gripe confirmada por laboratorio. Métodos: Se incluyeron todos los pacientes con diagnóstico de gripe por laboratorio que habían sido atendidos en el hospital y murieron durante las temporadas 2009-2010 a 2013-2014 en Navarra. La causa básica demuerte se obtuvo del Registro de Mortalidad. Resultados: Entre los 49 pacientes estudiados, la causa básica de muerte fue en el 35% gripe, en el 4% neumonía, en el 14% otras enfermedades respiratorias, en el 10% enfermedades cardiovasculares y en el 37% otras causas. Conclusiones: Un tercio de las muertes en pacientes con gripe confirmada se asignaron a causas no cardiorrespiratorias. Deberían tenerse en cuenta todas las causas para estimar la carga total de la mortalidad por gripe (AU)

Vaccine effectiveness in preventing laboratory-confirmed influenza in Navarre, Spain: 2013/14 mid-season analysis.

We estimate mid-2013/14 season vaccine effectiveness (VE) of the influenza trivalent vaccine in Navarre, Spain. Influenza-like illness cases attended in hospital (n=431) and primary healthcare (n=344) were included. The overall adjusted VE in preventing laboratory-confirmed influenza was 24% (95% CI: -14 to 50). The VE was 40% (95% CI: -12 to 68) against influenza A(H1)pdm09 and 13% (95% CI: -36 to 45) against influenza A(H3). These results suggest a moderate preventive effect against influenza A(H1)pdm09 and low protection against influenza A(H3).

[Attitudes, perceptions and factors associated with influenza vaccination among primary healthcare professionals in Navarre, 2011-2012]. / Actitudes, percepciones y factores asociados a la vacunación antigripal en los profesionales de atención primaria de Navarra, 2011-2012.

BACKGROUND: The influenza vaccine is recommended for all healthcare workers to protect their own health and their patients. We aimed to describe the influenza vaccine coverage in primary healthcare professionals in the 2011-12 season in Navarre and to study the factors associated with this coverage. METHODS: An anonymous web-based survey was sent to primary healthcare professionals in 2012. The survey collected information on the influenza vaccination status for the four previous seasons, the attitudes towards and knowledge of the vaccine, and socio-demographic and professional data. RESULTS: Of 1,083 professionals, 381 (35%) completed the survey: 54.3% nurses, 35.7% general practitioners and 10% paediatricians. In the 2011-12 season, 56.2% had received the influenza vaccine, without significant changes compared to previous seasons. The vaccination in any previous season was the main predictive factor for current vaccination (odds ratio (OR): 20.87; confidence interval (CI) 95%: 8.98-48.48). The vaccine coverage was higher among those living with persons with risk factors for influenza (OR: 1.72; CI 95%: 1.05-2.84), those worried about becoming ill (OR: 4.59; CI 95%: 2.30-9.15), or infecting their patients (OR: 6.29; IC 95%: 3.02-13.13). Participation in training activities on influenza or vaccines was not significantly associated with influenza vaccination. CONCLUSIONS: Influenza vaccination coverage in primary healthcare professionals in Navarre is below desirable levels. A greater involvement of healthcare professionals is necessary in the influenza prevention strategy.

Actitudes, percepciones y factores asociados a la vacunación antigripal en los profesionales de atención primaria de Navarra, 2011-2012 / Attitudes, perceptions and factors associated with influenza vaccination among primary healthcare professionals in Navarre, 2011-2012

Fundamento. La vacuna de la gripe está indicada en los profesionales sanitarios para proteger su salud y la de sus pacientes. El objetivo fue describir la cobertura de vacunación antigripal en los profesionales de atención primaria durante la temporada 2011-12 en Navarra y estudiar los factores asociados a la vacunación. Material y métodos. Se envió una encuesta anónima vía web a los profesionales de atención primaria en 2012. La encuesta recogió información sobre el estado de vacunación antigripal de las últimas temporadas, sobre las actitudes y conocimientos de la vacuna y datos sociodemográficos y profesionales. Resultados. De 1.083 profesionales, 381 (35%) completaron la encuesta: 54,3% profesionales de enfermería, 35,7% médicos de familia y 10% pediatras. En la temporada 2011-12 se habían vacunado el 56,2%, sin cambios significativos con respecto a temporadas previas. El principal predictor de la vacunación fue el haberse vacunado en alguna temporada previa (odds ratio (OR): 20,87; intervalo de confianza (IC) 95%: 8,98-48,48).Se vacunaron más los que tenían personas con factores de riesgo en la familia (OR: 1,72; IC 95%: 1,05-2,84), los que estaban preocupados por enfermar (OR: 4,59; IC 95%: 2,30-9,15) y por contagiar a sus pacientes (OR: 6,29; IC 95%: 3,02-13,13).El haber participado en actividades formativas sobre gripe y vacunas no influyó en la decisión de vacunarse. Conclusiones. La cobertura de vacunación entre los profesionales sanitarios de atención primaria de Navarra está por debajo de los niveles deseables. Se debe mejorar la implicación de los profesionales en la estrategia de prevención de la gripe (AU)

Background. The influenza vaccine is recommended for all healthcare workers to protect their own health and their patients. We aimed to describe the influenza vaccine coverage in primary healthcare professionals in the 2011-12 season in Navarre and to study the factors associated with this coverage. Methods. An anonymous web-based survey was sent to primary healthcare professionals in 2012. The survey collected information on the influenza vaccination status for the four previous seasons, the attitudes towards and knowledge of the vaccine, and socio-demographic and professional data. Results. Of 1,083 professionals, 381 (35%) completed the survey: 54.3% nurses, 35.7% general practitioners and 10%paediatricians. In the 2011-12 season, 56.2% had received the influenza vaccine, without significant changes compared to previous seasons. The vaccination in any previous season was the main predictive factor for current vaccination (odds ratio (OR): 20.87; confidence interval (CI) 95%:8.98-48.48). The vaccine coverage was higher among those living with persons with risk factors for influenza (OR: 1.72; CI 95%: 1.05-2.84), those worried about becoming ill (OR: 4.59; CI 95%: 2.30-9.15), or infecting their patients (OR: 6.29; IC 95%: 3.02-13.13). Participation in training activities on influenza or vaccines was not significantly associated with influenza vaccination. Conclusions. Influenza vaccination coverage in primary healthcare professionals in Navarre is below desirable levels. A greater involvement of healthcare professionals is necessary in the influenza prevention strategy (AU)

Early estimates of influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis.

We present estimates of influenza vaccine effectiveness (VE) in Navarre, Spain, in the early 2012/13 season, which was dominated by influenza B. In a population-based cohort using electronic records from physicians, the adjusted VE in preventing influenzalike illness was 32% (95% confidence interval (CI): 15 to 46). In a nested test-negative case-control analysis the adjusted VE in preventing laboratory-confirmed influenza was 86% (95% CI: 45 to 96). These results suggest a high protective effect of the vaccine.

Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12.

This study evaluates the influenza vaccine effectiveness (VE) in preventing laboratory-confirmed cases in Navarre, Spain, in the 2011/12 season in which the peak was delayed until week 7 of 2012. We conducted a test-negative case­control study. Patients with influenza-like illness in hospitals and primary healthcare were swabbed for testing by reverse transcription-polymerase chain reaction. Influenza vaccination status and other covariates were obtained from healthcare databases. The vaccination status of confirmed cases and negative controls was compared after adjusting for potential confounders. VE was calculated as (1-odds ratio)x100. The 411 confirmed cases (93% influenza A(H3)) were compared with 346 controls. Most characterised viruses did not match the vaccine strains. The adjusted estimate of VE was 31% (95% confidence interval (CI): -21 to 60) for all patients, 44% (95% CI: -11 to 72) for those younger than 65 years and 19% (95% CI: -146 to 73) for those 65 or older. The VE was 61% (95% CI: 5 to 84) in the first 100 days after vaccination, 42% (95% CI: -39 to 75) between 100 and 119 days, and zero thereafter. This decline mainly affected people aged 65 or over. These results suggest a low preventive effect of the 2011/12 seasonal influenza vaccine, and a decline in VE with time since vaccination.

Use of the vaccination register to evaluate influenza vaccine coverage in seniors in the 2010/11 influenza season, Navarre, Spain.

People aged 65 and older have a high risk of suffering from complications of influenza, therefore it is recommended that they receive annual influenza vaccination. However, vaccination coverage falls far short of the target of 75%. In this study we use the vaccination register to evaluate the coverage of influenza vaccine in non-institutionalised persons aged 65 and over in Navarre, Spain, in the 2010/11 season (104,427 persons). Vaccination coverage was 58.6%, lower than the 62.7% coverage in the 2009/10 season. In the multivariate analysis, lower coverage was associated with being female, age under 80 or over 94 years, immigrant status and hospitalisation in the previous year. In contrast, persons with major chronic conditions, high level of dependence or those with more visits to the general practitioner in the previous year had higher vaccination coverage. Influenza vaccination in the previous season was a strong predictor of vaccination in the current season (odds ratio: 37.0, 95% confidence interval: 35.7­38.4). The vaccination register has been shown to be useful to monitor the coverage of influenza vaccination in seniors and may help guide strategies to improve coverage.

Effectiveness of trivalent seasonal and monovalent influenza A(H1N1)2009 vaccines in population with major chronic conditions of Navarre, Spain: 2010/11 mid-season analysis.

We defined a cohort of people with major chronic conditions (152,585 subjects) in Navarre, Spain, using electronic records from physicians, to obtain 2010/11 mid-season estimates of influenza vaccine effectiveness. The adjusted estimates of the effectiveness of the 2010/11 trivalent influenza vaccine were 31% (95% confidence interval (CI): 20­40%) in preventing medically attended influenza-like illness, and 58% (95% CI: 11­80%) in preventing laboratory-confirmed influenza. Having received the monovalent influenza A(H1N1)2009 vaccine in the 2009/10 season had an independent preventive effect against medically attended influenza-like illness (17%, 95% CI: 1­30%), and having received both vaccines had 68% (95% CI: 23­87%) effectiveness in preventing laboratory-confirmed influenza.