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.

Influenza outbreaks in nursing homes with high vaccination coverage in Navarre, Spain, 2011/12.

In the 2011/12 season, three influenza outbreaks were studied in nursing homes with high vaccination coverage in Navarre, Spain. Attack rates ranged from 2.9% to 67%. Influenza A/Stockholm/18/2011(H3N2) virus strain was isolated from the three outbreaks. Vaccination should be complemented with other hygiene measures in nursing homes. Early detection of influenza outbreaks in nursing homes can aid in their control.

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.

Caracterización de la pandemia de gripe A H1N1 2009 en Navarra / The 2009 H1N1 influenza pandemic in Navarre, Spain

Fundamento. Describir la actividad gripal durante la pandemia de 2009-2010 en Navarra y compararla con la de temporadas anteriores. Métodos. Se han analizado los casos de gripe notificados en atención primaria y todas las confirmaciones virológicas realizadas en pacientes de atención primaria y en hospitales de Navarra entre las semanas 21 de 2009 y 20 de 2010. Resultados. El virus de la gripe A (H1N1) 2009 se detectó en Navarra entre las semana 23 de 2009 a la 2 de 2010, periodo en el que se registraron 39 casos con diagnóstico médico de síndrome gripal por 1.000 habitantes. El umbral epidémico se superó en dos periodos, con un pico en julio y otro mayor en noviembre. La mayor incidencia se alcanzó en niños de 5 a 14 años (121 por mil), seguidos por el grupo de menores de 5 años. Se produjeron 224 hospitalizaciones (36 por 100.000 habitantes) con confirmación de gripe A H1N1 2009, 8% de ellos requirieron ingreso en unidades de cuidados intensivos y hubo cuatro defunciones (0,6 por 100.000 habitantes). La tasa de hospitalizaciones fue mayor en niños menores de 5 años (163 por 100.000 habitantes), mientras que la probabilidad de derivación a cuidados intensivos aumentó con la edad. Conclusión. A pesar de no haber dispuesto de una vacuna específica hasta que la temporada estaba muy avanzada, el virus de gripe A (H1N1) 2009 produjo una onda gripal en rangos similares a los de otras temporadas y su repercusión en hospitalizaciones y casos graves fue moderada (AU)

Background. To describe influenza activity during the2009-2010 pandemic in Navarre and compare it to previous seasons. Methods. An analysis was made of all influenza-like illness cases reported in primary care and all the virological confirmations made in patients in primary care and in hospitals of Navarre between week 21 of 2009 and week 20 of 2010. Results. Influenza 2009 H1N1 virus was detected in Navarre between week 23 of 2009 and week 2 of 2010, a period when 39 medically diagnosed cases of influenza-like illness per 1,000 inhabitants were registered. The epidemicthres hold was surpassed in two periods, with a peak in July and a greater one in November. The greatest incidence was reached in children aged between 5 and 14 years (121 per thousand), followed by the group of under fives.There were 224 hospitalisations (36 per 100,000 inhabitants)with confirmation of influenza 2009 H1N1 virus, 8% of whom required admission to intensive care units and there were four deaths (0.6 per 100,000 inhabitants). The rate of hospitalisation was greater amongst children under five (163 per 100,000 inhabitants), while the probability of referral to intensive care increased with age. Conclusion. In spite of not having a specific vaccine available until the season was very well advanced, influenza 2009 H1N1 virus produced a wave of cases with similar incidence to those of other seasons and its repercussion in hospitalizations and serious cases was moderate (AU)

[The 2009 H1N1 flu pandemic in Navarre, Spain]. / Caracterización de la pandemia de gripe a H1N1 2009 en Navarra.

BACKGROUND: To describe flu activity during the 2009-2010 pandemic in Navarre and compare it to previous seasons. METHODS: An analysis was made of all flu cases reported in primary care and all the virological confirmations made in patients in primary care and in hospitals of Navarre between week 21 of 2009 and week 20 of 2010. RESULTS: Influenza A (H1N1) Virus 2009 was detected in Navarre between week 23 of 2009 and week 2 of 2010, a period when 39 medically diagnosed cases of flu syndrome per 1,000 inhabitants were registered. The epidemic threshold was surpassed in two periods, with a peak in July and a greater one in November. The greatest incidence was reached in children aged between 5 and 14 years (121 per thousand), followed by the group of under fives. There were 224 hospitalisations (36 per 100,000 inhabitants) with confirmation of Influenza A (H1N1) Virus 2009, 8% of whom required admission to intensive care units and there were four deaths (0.6 per 100,000 inhabitants). The rate of hospitalisation was greater amongst children under five (163 per 100,000 inhabitants), while the probability of referral to intensive care increased with age. CONCLUSION: In spite of not having a specific vaccine available until the season was very well advanced, Influenza A (H1N1)Virus 2009 produced a flu wave with similar levels to those of other seasons and its repercussion in hospitalisations and serious cases was moderate.

[Intermittent hematuria. Vesical schistosomosis. Concerning one case]. / Hematuria intermitente. Esquistosomiasis vesical. A propósito de un caso.

We present a clinical case of vesical schistosomiasis that we consider unusual in our environment. The clinical features of this parasitosis include an intermittent hematuria of several weeks evolution which is not resolved with the usual treatment. Due to the increase in the immigrant population arriving from endemic areas, we must pay greater attention to this emergent pathology. The process is resolved satisfactorily with treatment and complications are avoided.

Hematuria intermitente. Esquistosomiasis vesical. A propósito de un caso / Intermittent hematuria. Vesical schistosomosis. Concerning one case

Presentamos un caso clínico de un paciente con esquistosomiasis vesical que consideramos inusual en nuestro entorno. El cuadro clínico de esta parasitosis es habitualmente el de una hematuria intermitente de semanas de evolución que no se resuelve con las medidas terapéuticas habituales. Debido al aumento de población inmigrante procedente de áreas endémicas, debemos pensar cada vez más en esta patología emergente. Con el tratamiento el proceso se resuelve satisfactoriamente, pudiéndose evitar sus complicaciones (AU)

We present a clinical case of vesical schistosomiasis that we consider unusual in our environment. The clinical features of this parasitosis include an intermittent hematuria of several weeks evolution which is not resolved with the usual treatment. Due to the increase in the immigrant population arriving from endemic areas, we must pay greater attention to this emergent pathology. The process is resolved satisfactorily with treatment and complications are avoided (AU)

A large Legionnaires' disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality.

An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

[Hepatitis A seroprevalence in Navarra]. / Seroprevalencia de hepatitis A en Navarra.

BACKGROUND: Determine the hepatitis A seroprevalence in Navarra. Because of the improvement in the hygienic-sanitary conditions, we hope to find a decline of the total prevalence. METHODS: Population and random sample of Navarra, obtained by stratified sampling with proportional allocation of sex, age, and area of health care: 1,440 individuals over 15 years of age. Detection of total antibodies by enzyme immunoassay of microparticles. RESULTS: Global seroprevalence: 79.24%. By age: 9.09% (16-19 years), 35.32% (20-29 years), 77.78% (30-39 years), 97.31% (40-49 years), 98.58% (50-59 years), 97.51% (60-69 years), 99.33% (70-79 years) and 100% (>79 years). By gender: 78.76% in men and 79.7% in women. Rural area 82.04% and urban area 75.77%. Areas of health care: Tafalla, 89.06%; Estella, 87.91%; Tudela, 82.88%; northern, 77.22%; Pamplona, 75.05%, and eastern, 70.97%. CONCLUSIONS: The global prevalence is 79.24% and increasing progressively with the age. Greater seroprevalence in rural areas and in people in contact with livestock. Characteristics of the persons with seroprevalence for HAV in Navarra: inhabitant of the average area, of rural area, with average age and in contact with livestock.

Evaluation of the MB/BacT system compared with Middlebrook 7H11 and Lowenstein-Jensen media for detection and recovery of mycobacteria from clinical specimens.

MB/BacT vials (an automated system), Middlebrook 7H11 agar plates with the microcolony method for growth detection, and conventional Lowenstein-Jensen egg-based medium were assessed for their rates of recovery, time to detection and ease in aiding the identification of mycobacterial isolates. Of the 2101 consecutive, non-selected specimens for tuberculosis analysed in the laboratory, 158 (7.5%) yielded growth of 159 mycobacteria on at least one of the three media, comprising 111 Mycobacterium tuberculosis and 48 non-tuberculous mycobacteria. Of the 111 specimens positive for M. tuberculosis, 100 isolates were recovered from MB/BacT vials, 99 from M7H11 agar plates, and 86 from Lowenstein-Jensen tubes. The combination of MB/BacT and M7H11 recovered 110 isolates of M. tuberculosis, 107 from M7H11 and Lowenstein-Jensen, and 105 from MB/BacT plus Lowenstein-Jensen. The average time to detection of M. tuberculosis was 11 days with M7H11 using the microcolony method, 16 days with MB/BacT, and 19.5 days with the conventional Lowenstein-Jensen method. The MB/BacT vials recovered greater numbers of non-tuberculous mycobacteria than either of the other two media, but these were considered mostly to be saprophytes. It was concluded that a combination of media was better than a single medium. None of the media combinations showed statistical differences. Use of M7H11 with the microcolony method, which shortens the detection time for mycobacteria and facilitates the detection of mixed cultures, together with the Lowenstein-Jensen tube, was a useful combination.

Seroprevalencia de hepatitis A en Navarra / Hepatitis A seroprevalence in Navarra

Fundamento. Determinar la seroprevalencia de hepatitis A en Navarra. Debido a las mejoras en las condiciones higienicosanitarias esperamos encontrar un descenso de la prevalencia total. Métodos. Muestra poblacional y aleatoria de Navarra obtenida por muestreo estratificado con asignación proporcional de sexo, edad y área de salud: 1.440 individuos mayores de 15 años. Detección de anticuerpos totales por enzimoinmunoensayo de micropartículas. Resultados. Seroprevalencia global: 79,24 por ciento. Por edades: 9,09 por ciento (16-19 años), 35,32 por ciento (20-29 años), 77,78 por ciento (30-39 años), 97,31 por ciento (40-49 años), 98,58 por ciento (50-59 años), 97,51 por ciento (60-69 años), 99,33 por ciento (70-79 años) y 100 por ciento (>79 años). Por sexos: 78,76 por ciento en varones y 79,7 por ciento en mujeres. Ámbito rural: 82,04 por ciento y urbano: 75,77 por ciento. Áreas de salud: Tafalla, 89,06 por ciento; Estella, 87,91 por ciento; Tudela, 82,88 por ciento; norte, 77,22 por ciento; Pamplona, 75,05 por ciento, y este, 70,97 por ciento. Conclusiones. La prevalencia global es 79,24 por ciento, aumentando progresivamente con la edad. Mayor seroprevalencia en zonas rurales y en personas en contacto con ganado. Perfil de la persona seroprevalente para virus de la hepatitis A (VHA) en Navarra: habitante de la zona media, de ámbito rural, mediana edad y en contacto con ganado (AU)

Vigilancia epidemiológica del VIH/SIDA en Navarra / Epidemiological surveillance of HIV/AIDS in Navarra

Han pasado más de 15 años desde que en 1985 se diagnosticaron en Navarra los primeros casos de SIDA. Desde entonces y hasta diciembre de 2001 según las notificaciones recibidas se han contabilizado 2.400 personas con infección por VIH, de las que aproximadamente 700 han desarrollado SIDA y 565 han fallecido por SIDA u otras causas. La incidencia de nuevas infecciones por VIH, casos de SIDA y muertes relacionadas con éste muestran una clara tendencia descendente en Navarra en los últimos años. La disminución de casos es muy importante entre los usuarios de drogas de inyección, mientras que los casos entre los homo/bisexuales masculinos y entre las personas infectadas tras una relación heterosexual se mantienen bastante estables. Por primera vez, a partir de 1999, las personas infectadas a través de una relación sexual son más numerosas que los usuarios de drogas por vía parenteral. La proporción de casos de SIDA e infección en personas originarias de países de alta endemia está aumentando, llegando a suponer el 23 por ciento de los nuevos casos de infección en los años 2000 y 2001. Los datos de Navarra reflejan igualmente la importante reducción de casos de SIDA y muertes relacionadas con el SIDA desde que en 1996 se introdujeron los tratamientos antirretrovirales más eficaces. Las estrategias para la detección de la infección por VIH en las personas que hayan mantenido prácticas de riesgo es importante si consideramos que en los años 2000 y 2001, en uno de cada 5 pacientes el diagnóstico de infección y enfermedad fue simultáneo lo que implica que estas personas no se beneficiaron de los tratamientos de la misma manera que si el diagnóstico hubiese sido anterior (AU)

[Epidemiological surveillance of HIV/AIDS in Navarra]. / Vigilancia epidemiológica del VIH/SIDA en Navarra.

More than fifteen years have passed since the first cases of AIDS were diagnosed in Navarra in 1985. According to the notifications received from then until December 2001, 2,400 people have been counted with HIV infection, of whom approximately 700 have developed AIDS, and 565 have died of AIDS or other causes. The incidence of new infections by HIV, cases of AIDS and deaths related to the latter, have shown a clear tendency to decline in Navarra in recent years. The decrease in cases is very important amongst the users of intravenous drugs, while the cases amongst masculine homo/bisexuals and amongst persons infected following a heterosexual encounter have remained fairly stable. For the first time, starting in 1999, persons infected through a sexual encounter are higher than the users of parenteral drugs. There has been an increase in the proportion of cases of AIDS and infection in persons originating from countries where the disease is endemic, accounting for over 23% of new cases of infection in the years 2000 and 2001. The figures for Navarra also reflect the important reduction of cases of AIDS and AIDS-related deaths since the introduction of more efficient anti-retroviral treatments in 1996. The strategies for the detection of HIV infection in persons who have maintained risk practices is important if we consider that in the years 2000 and 2001, there was a simultaneous diagnosis of infection and disease in one in every five patients. This implies that these persons did not benefit from treatments in the same way as they would have if the diagnosis had been made earlier.

Leptospirosis en inmunocompetentes / Leptospirosis in immunocompetent patients

No disponible

[Trichinellosis: study of 2 outbreaks in Navarre]. / Triquinelosis: estudio de dos brotes en Navarra.

BACKGROUND: We present two outbreaks of trichinosis occurred in the last two years in Navarre. METHODS: After the detection of the initial case, an epidemiological study of all people presumably infected was carried out. We used the latex agglutination and ELISA tests to detect specific antibodies. We studied the characteristics of the infested meat, as well as the clinical symptoms, eosinophil counts and serologic status of the subjects. After three and twelve months those items were again monitored. RESULTS: 71 subjects who had ingested the infected meat were detected. Of them, 67 (94.3%) were enrolled in the study, 34 being involved in the first outbreak and 33 in the second. 15 (22.5%) of the 67 cases had symptoms suggestive of trichinosis, 30 (44.7%) had hypereosinophilia, and 25 (38%) had positive serologic test results. 25 subjects (38%) were diagnosed as having trichinosis. Two groups were made according to the characteristics of the meat consumed: 34 subjects (50.7%) had ingested thoroughly cooked meat (group A), whereas 33 (49%) had ingested poorly cooked meat (group B). After three months, only 5 patients were symptomatic and 10 had a high eosinophil count. After 12 months, all subjects were asymptomatic, had normal eosinophil counts and negative serologies. CONCLUSIONS: 1) An epidemiological survey and serologic determinations for trichina should be carried out when studying hypereosinophilia. 2) It is important to insist on the necessity of veterinary inspection of home-made pork products. 3) The ingestion of poorly cooked pork products increases the risk of Trichinella infection.

Short report: an outbreak of trichinosis in Navarra, Spain.

Trichinosis is an infection contracted by ingestion of meat containing viable larvae of the nematode Trichinella spiralis. This report concerns an outbreak of infections with this parasite in Navarra, Spain that was associated with home-prepared pork products. After the detection of a person with trichinosis, a study of all subjects that had ingested meat from the presumably infected pork was carried out. Forty-four members of eight families were enrolled in the study. Ten had symptoms suggestive of trichinosis, 20 had hypereosinophilia, and 15 had positive serologic test results for anti-Trichinella antibodies. Three groups could be distinguished according to the kind of product each subject had ingested (pork sausage, blood pudding, and loin). Twelve months later, all had a normal eosinophil count and a negative serology.

[Hepatitis B vaccination: immunogenicity of the plasmatic vaccine in hospital personnel]. / Vacunación contra la hepatitis B: inmunogenicidad de la vacuna plasmática en personal hospitalario.

The results and incidences of a hepatitis B vaccination program were evaluated in 310 health professionals from a general hospital constituting 26.8% of the whole staff. They were 102 males and 208 females which, on the basis of previous criteria, were inoculated with plasmatic vaccine (MSD) in the deltoid muscle. In only 299 (100 males and 199 females), post vaccination control laboratory studies were available. The overall antiHBs seroconversion rate was 95%; it was 92% in males and 96% in females, without significant differences (p greater than 0.05). The age group below 30 years had a better response (97%) than the 30-49 years group (95%), and this, in its turn, better than that over 50 years (90%), but the differences between groups were not significant (p greater than 0.05). The immune response was satisfactory (greater than 100 mUI/ml) in 85% of the study group, and in only 5% it was negative or scarcely measurable. The application of a fourth vaccine dose to nonresponders had variable results. In 20% of the vaccinated individuals adverse reactions were noted, more frequently after the first vaccine dose. We wish to emphasize that a vaccination program such as this demands a great planning, organization and follow-up effort to achieve success and cost-effectiveness. Importantly, it should be avoided that vaccination create a feeling of false security among health professionals inducing them to neglect other protective measures.