The impact of COVID-19 pandemic on the incidence of acute gastroenteritis outbreaks in Catalonia (Spain).

We carried out a retrospective study of acute gastroenteritis (AGE) outbreaks reported between 1 January 2015 and 31 December 2021 in Catalonia (Spain) to compare the incidence from 2015 to 2019 with that observed from 2020 to 2021. We observed a higher incidence rate of outbreaks during the prepandemic period (16.89 outbreaks/1,000,000 person-years) than during the pandemic period (6.96 outbreaks/1,000,000 person-years) (rate ratio (RR) 0.41; 95% confidence interval (CI) 0.34 to 0.51). According to the aetiology of the outbreak, those of viral aetiology decreased from 7.82 to 3.38 outbreaks/1,000,000 person-years (RR 2.31; 95% CI 1.72 to 3.12), and those of bacterial aetiology decreased from 5.01 to 2.78 outbreaks/1,000,000 person-years (RR 1.80; 95% CI 1.29 to 2.52). There was a great reduction in AGE outbreaks in Catalonia. This reduction may have been due to the effect of the nonpharmaceutical measures applied to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the collapse of the healthcare system and epidemiological surveillance services may also have had a strong influence.

Effectiveness of maternal pertussis vaccination in protecting newborn: A matched case-control study.

INTRODUCTION: The objective was to estimate the effectiveness of maternal pertussis vaccination in protecting infants aged < 2 months. METHODS: We performed a case-control study. Laboratory-confirmed cases aged <8 weeks at disease onset were identified and 2-4 matched-controls born within ± 15 days of the case were included. Information was obtained from healthcare providers and maternal interviews. Odds ratios (OR) were calculated using multivariable conditional logistic regression. Vaccine effectiveness (VE) was estimated as (1 - OR) × 100%. RESULTS: 47 cases and 124 controls were studied. The mean age (in days) (39.8 ± 12.7 vs. 40.8 ± 13.2), weeks of gestation (38.8 vs. 39.1, p = 0.43) and mean birth weight (3.309 vs. 3.253 kg, p = 0.55) were comparable between cases and controls. Mothers of cases were less frequently vaccinated in the third trimester (59.6% vs. 83.9%, p <0.001). The VE of maternal vaccination in pregnancy was 88.0% (95%CI 53.8% -96.5%), and was slightly higher in those vaccinated before the 32nd week of gestation (88.5% vs 87.8%). CONCLUSION: Pertussis vaccination in pregnancy is very effective in reducing pertussis in children aged < 2 months. Vaccination before and after the 32nd week of pregnancy are equally effective in reducing the risk of pertussis.

Acute gastroenteritis outbreaks in closed and semi-closed facilities during 2017 in Catalonia, Spain.

Acute gastroenteritis (AGE) is a leading cause of disease worldwide. The aim of this prospective observational study is to describe the epidemiology of AGE in closed and semi-closed institutions in Catalonia. In 2017, 151 outbreaks were reported; 30.5% occurred in closed and semi-closed institutions; 71.7% caused by norovirus (NoV) (1532) cases. Person-to-person transmission accounted for 75.8% of NoV outbreaks vs 46.1% in non-NoV outbreaks (p < 0.001). Attack rate for NoV outbreaks was 33.1% vs 14.3% for non-NoV outbreaks (RR = 2.3; 95%CI: 2.0-2.7). The high number of affected underscores prompt and intense preventive measures to avoid the extension and perpetuation of outbreaks in these settings.

Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012-2013.

We retrospectively assessed the effectiveness of azithromycin in preventing transmission of pertussis to a patient's household contacts. We also considered the duration between symptom onset in the primary patient and azithromycin administration. We categorized contacts into 4 groups: those treated within <7 days, 8-14 days, 15-21 days, and >21 days after illness onset in the primary patient. We studied 476 primary index patients and their 1,975 household contacts, of whom 4.5% were later identified as having pertussis. When contacts started chemoprophylaxis within <21 days after the primary patient's symptom onset, the treatment was 43.9% effective. Chemoprophylaxis started >14 days after primary patient's symptom onset was less effective. We recommend that contacts of persons with pertussis begin chemoprophylaxis within <14 days after primary patient's symptom onset.

Diagnóstico post mortem de septicemia neumocócica en una mujer joven con hiposplenia / Post-mortem diagnosis of pneumococcal septicaemia in young woman with hyposplenia

La enfermedad neumocócica es una importante causa de morbimortalidad. La descripción de casos de identificación post mortem de Streptococcus pneumoniae (SP) es infrecuente. Presentamos un caso de fallecimiento por sepsis fulminante secundaria a SP en una mujer joven con factores de riesgo. Se trata de un fallecimiento comunicado por urgencias hospitalarias como una parada cardiaca extrahospitalaria de posible origen abdominal. La autopsia judicial reveló hallazgos compatibles con un cuadro de sepsis fulminante, por lo que se comunicó a vigilancia epidemiológica de salud pública. Se realizaron estudios microbiológicos post mortem, que permitieron aislar SP en el cultivo de líquido pleural, posteriormente la PCR en sangre identificó SP y se caracterizó el serotipo (22F). A pesar de que la hipoesplenia era conocida desde la adolescencia y ser una indicación de vacunación, la paciente no estaba vacunada frente al SP por ninguna de las 2 vacunas actualmente recomendadas en España

Pneumococcal infections are a significant cause of morbidity and mortality. Post-mortem identification of Streptococcus pneumoniae (SP) is uncommon. A case of death due to fulminant pneumococcal septicaemia in a young woman with hyposplenia is presented. The death was notified by the hospital emergency department as an out-of-hospital cardiac arrest of possible abdominal aetiology. Forensic autopsy found changes suggestive of fulminant septicaemia and the public health epidemiology service was informed. Post-mortem microbiology studies were carried out, in which SP was isolated in the pleural fluid culture, and later PCR in blood identified SP, as well as determining and the serotype (22F). Although hyposplenia was known since adolescence, and was an indication of vaccination, the patient was not vaccinated against SP by any of the two currently recommended vaccines in Spain

Descriptive study of severe hospitalized cases of laboratory-confirmed influenza during five epidemic seasons (2010-2015).

OBJECTIVE: The Plan of Information on Acute Respiratory Infections in Catalonia (PIDIRAC) included the surveillance of severe hospitalized cases of laboratory-confirmed influenza (SHCLCI) in 2009. The objective of this study was to determine the clinical, epidemiological and virological features of SHCLCI recorded in 12 sentinel hospitals during five influenza seasons. RESULTS: From a sample of SHCLCI recorded during the 5 influenza epidemics seasons from 2010-2011 to 2014-2015, Cases were confirmed by PCR and/or viral isolation in cell cultures from respiratory samples. A total of 1400 SHCLCI were recorded, 33% required ICU admission and 12% died. The median age of cases was 61 years (range 0-101 years); 70.5% were unvaccinated; 80.4% received antiviral treatment (in 79.6 and 24% of cases within 48 h after hospital admission and the onset of symptoms, respectively); influenza virus A [37.9% A (H1N1)pdm09, 29.3% A (H3N2)] was identified in 87.7% of cases. Surveillance of SHCLCI provides an estimate of the severity of seasonal influenza epidemics and the identification and characterization of at-risk groups in order to facilitate preventive measures such as vaccination and early antiviral treatment.

Effectiveness of hepatitis A vaccination as post-exposure prophylaxis.

Hepatitis A (HA) has been a vaccine-preventable disease since 1995. In Catalonia, a universal combined hepatitis A+B vaccination program of preadolescents was initiated at the end of 1998. However, outbreaks are reported each year and post-exposure prophylaxis (PEP) with hepatitis A virus (HAV) vaccine or immunoglobulin (IG) is recommended to avoid cases. The aim of this study was to assess the effectiveness of HAV vaccine and IG in preventing hepatitis A cases in susceptible exposed people. A retrospective cohort study of contacts of HA cases involved in outbreaks reported in Catalonia between January 2006 and December 2012 was made. The rate ratios and 95% confidence intervals (CI) of HA in susceptible contacts receiving HAV or IG versus those without PEP were calculated. There were 3550 exposed persons in the outbreaks studied: 2381 received one dose of HAV vaccine (Hepatitis A or hepatitis A+B), 190 received IG, and 611 received no PEP. 368 exposed subjects received one dose of HAV vaccine and IG simultaneously and were excluded from the study. The effectiveness of PEP was 97.6% (95% CI 96.2-98.6) for HAV vaccine and 98.3% (95% CI 91.3-99.9) for IG; the differences were not statistically significant (p = 0.36). The elevated effectiveness of HAV vaccination for PEP in HA outbreaks, similar to that of IG, and the long-term protection of active immunization, supports the preferential use of vaccination to avoid secondary cases.

Characterization of unrelated clinical Legionella pneumophila isolates in Catalonia by monoclonal subgrouping and sequence-based typing.

AIM: To characterize the genetic diversity of unrelated Legionella pneumophila clinical isolates in Catalonia and compare with other European regions. METHODS: 95 unrelated isolates were analyzed using monoclonal antibodies and sequence-based typing, 1989-2013. RESULTS: The isolates showed a high diversity (IOD 0.964) with a predominance of some profiles (ST37-Phialdelphia, ST23-Philadelphia and ST1-OLDA). All regions had predominant sequence types (STs) that differed between regions, and only 3% of STs were shared between the three regions. CONCLUSION: L. pneumophila clinical isolates from Catalonia presented a high diversity and can be used in epidemiological surveillance studies. The heterogeneous predominance of STs between European regions suggested a relationship between geographical distribution and virulence of some STs.

Changes in the epidemiology of hepatitis A outbreaks 13 years after the introduction of a mass vaccination program.

A hepatitis A+B vaccine vaccination program of 12-year-olds was introduced in Catalonia in 1998. The aim of this study was to investigate the evolution of hepatitis A outbreaks in Catalonia and estimate the preventable fraction of cases associated with outbreaks as a measure of the impact of the vaccination program. Hepatitis A outbreaks reported to the Health Department between 1991 and 2012 were analyzed. The incidence rates of outbreaks, outbreak-associated cases and hospitalizations were calculated. The preventable fraction (PF) and 95% confidence intervals (CI) were estimated for the whole study period (pre-vaccination and post-vaccination) and the post-vaccination period.   One-hundred-eight (108) outbreaks (rate of 2.21 per 10(6) persons-year) were reported in the pre-vaccination period and 258 outbreaks (rate of 2.82 per 10(6) persons-year) in the post-vaccination period. The rate of cases associated with outbreaks was 1.52 per 10(5) persons-year in the pre-vaccination period and 1.28 per 10(5) persons-year in the post-vaccination period. Hospitalization rates were 0.08 and 0.75 per 10(6) persons-year, respectively. The number of person-to-person outbreaks whose index case was a school contact decreased in the post-vaccination period (aOR 2.72; 95%CI 1.35-5.48), but outbreaks whose index case was a man who has sex with men (MSM) or an immigrant increased. The PF of all outbreak-associated cases was 6.46% (95%CI 3.11-9.82) and the highest PF was in the 15-24 years age group (42.53%; 95%CI 29.30-55.75). In the 0-4 years age group, the PF was 18.35% (95%CI 9.59-27.11), suggesting a protective herd effect in unvaccinated subjects. Vaccination of immigrants traveling to endemic countries and MSM should be reinforced.

Immigrants do not transmit tuberculosis more than indigenous patients in Catalonia (Spain).

BACKGROUND: Immigrants may not transmit tuberculosis (TB) more than indigenous patients. The objective was to study the prevalence of TB infection among contacts of immigrant and indigenous TB patients and the risk factors associated with latent TB infection. METHODS: Contacts of TB cases recorded in 2005 and 2006 were surveyed using a standardized Health Department questionnaire. Infections were diagnosed using the tuberculin skin test (TST) (cut-off ≥ 5 mm). The risk of infection was determined by multivariate logistic regression and the adjusted odds ratios (aOR) with the 95% confidence intervals (CI) were calculated. RESULTS: The study of contacts was completed in 1329 cases of TB. The prevalence of infection was 32.3% (3038/9406) in all contacts, 41.4% in contacts of immigrant cases and 29.2% in contacts of indigenous cases. In the multivariate analysis, immigrant index cases were not associated with an increased risk (aOR = 0.9; 95%CI: 0.8-1.0). The prevalence of TST conversion was 10.0% (296/2969) in all contacts, 11.2% in immigrant contacts and 9.7% in indigenous contacts (p = 0.158). CONCLUSIONS: Immigrants do not transmit TB more than indigenous TB patients. Infections which may have occurred in the countries of origin of immigrants were detected by the systematic study of contacts.

Epidemiology of two large measles virus outbreaks in Catalonia: what a difference the month of administration of the first dose of vaccine makes.

Measles cases in the European Region have been increasing in the last decade; this illustrates the challenge of what we are now encountering in the form of pediatric preventable diseases. In Catalonia, autochthonous measles was declared eliminated in the year 2000 as the result of high measles-mumps-rubella vaccine (MMR) coverage for first and second dose (15 mo and 4 y) since the mid-1990s. From then on, sporadic imported cases and small outbreaks appeared, until in 2006-2007 a large measles outbreak affecting mostly unvaccinated toddlers hit the Barcelona Health Region. Consequently, in January 2008, first dose administration of MMR was lowered from 15 to 12 mo of age. A new honeymoon period went by until the end of 2010, when several importations of cases triggered new sustained transmission of different wild measles virus genotypes, but this time striking young adults. The aim of this study is to show the effect of a change in MMR vaccination schedule policy, and the difference in age incidence and hospitalization rates of affected individuals between both outbreaks.   Epidemiologic data were obtained by case interviews and review of medical records. Samples for virological confirmation and genotyping of cases were collected as established in the Measles Elimination plan guidelines. Incidence rate (IR), rate ratio (RR) and their 95% CI and hospitalization rate (HR) by age group were determined. Statistic z was used for comparing proportions. Total number of confirmed cases was 305 in the 2010 outbreak and 381 in the 2006-2007 outbreak; mean age 20 y (SD 14.8 y; 3 mo to 51 y) vs. 15 mo (SD 13.1 y; 1 mo to 50 y). Highest proportion of cases was set in ≥ 25 y (47%) vs. 24.2% in 2006 (p < 0.001). Differences in IR for ≤ 15 mo (49/100,000 vs. 278.2/100,000; RR: 3,9; 95%CI 2,9-5.4) and in overall HR 29.8% vs. 15.7% were all statistically significant (p < 0.001). The change of the month of age for the administration of the first MMR dose proved successful to protect infants. Yet, given the current epidemiological situation, continued awareness and efforts to reach young adult population, especially those at high risk of infection and transmission such as healthcare workers and travelers, are needed to stop the spread of the virus when importations occur.

Factors associated to duration of hepatitis a outbreaks: implications for control.

Even though hepatitis A mass vaccination effectiveness is high, outbreaks continue to occur. The aim of this study was to investigate the association between duration and characteristics of hepatitis A outbreaks. Hepatitis A (HA) outbreaks reported between 1991 and 2007 were studied. An outbreak was defined as ≥2 epidemiologically-linked cases with ≥1 case laboratory-confirmed by detection of HA immunoglobulin M (IgM) antibodies. Relationships between explanatory variables and outbreak duration were assessed by logistic regression. During the study period, 268 outbreaks (rate 2.45 per million persons-year) and 1396 cases (rate 1.28 per 10(5) persons-year) were reported. Factors associated with shorter duration were time to intervention (OR = 0.96; 95% CI: 0.94-0.98) and school setting (OR = 0.39; 95% CI: 0.16-0.92). In person-to-person transmission outbreaks only time to intervention was associated with shorter outbreak duration (OR = 0.96; 95% CI: 0.95-0.98). The only variables associated with shorter outbreak duration were early administration of IG or vaccine and a school setting. Timely reporting HA outbreaks was associated with outbreak duration. Making confirmed HA infections statutory reportable for clinical laboratories could diminish outbreak duration.

Transmisión de los primeros casos en España de influenza pandémica A/H1N1 / Pandemic A/H1N1 influenza: Transmission of the first cases in Spain

Introducción El virus de la influenza pandémica A/H1N1 surgió en México a finales de marzo del 2009. Desde entonces, es todavía importante aportar las evidencias que contribuyeron a la rápida propagación internacional del virus y determinar la tasa de ataque de esta nueva cepa de influenza entre los primeros casos que llegaron a España y llevaron a identificar la primera transmisión en Europa. Métodos Se estudiaron tres grupos de personas con sospecha de casos de virus de la gripe pandémica A/H1N1 relacionados con un vuelo internacional: 71 estudiantes que viajaban juntos, 94 pasajeros que viajaban en el mismo avión que el grupo de estudiantes, y 68 contactos de casos confirmados. Se calculó la tasa de ataque entre los estudiantes y los contactos con su intervalo de confianza del 95% (IC). El 26 de abril, cuando los primeros casos fueron notificados, se llevaron a cabo medidas de prevención exhaustivas entre el grupo de alumnos y de los contactos de los casos confirmados. Resultados El 27 de abril, los primeros casos de influenza pandémica A/H1N1 confirmados en España fueron tres estudiantes que regresaban de México en avión. Un estudiante dio lugar al primer caso autóctono en España y a uno de los primeros casos en Europa. Se encontraron tasas de ataque similares entre el grupo de estudiantes (14,1%; IC: 12.1-16.1) y sus contactos (13,2%; IC: 4.4-22.0), pero no se detectó ningún caso entre el resto de pasajeros del vuelo, lo que sugiere que el riesgo de transmisión durante el vuelo fue bajo. Conclusión Los primeros casos de gripe A/H1N1 en España fueron importados por vía aérea desde México. Los esfuerzos de prevención para reducir el impacto de la nueva cepa de influenza influyeron en que tanto la tasa de ataque primaria como la secundaria fueran menores a las primeras tasas estimadas por la OMS para esta nueva cepa de influenza (AU)

Introduction Pandemic A/H1N1 influenza emerged in Mexico at the end of March 2009. Since then, it is still important to provide evidences that contributed to the international spread of the virus and to ascertain the attack rate of this new strain of influenza among the first cases in Spain that led to identify the first transmission in Europe. Methods Three pandemic A/H1N1 influenza groups related to an overseas flight were studied: 71 student group, 94 remaining passengers, and 68 contacts of confirmed cases. The attack rate with their 95% confidence interval (CI) among the student group and contacts was calculated. On April 26th, when the first cases were notified, strong preventive measures were implemented among the student group and the contacts of the confirmed cases. Results On 27th April, the first pandemic A/H1N1 influenza cases confirmed in Spain were three students that came back from Mexico by airplane. A student generated the first native case in Spain and one of the first cases in Europe. Similar attack rates were found between the student group (14.1%; CI: 12.1-16.1) and their contacts (13.2%; CI: 4.4-22.0), but no cases among remaining passengers were detected, suggesting low transmission risk during air travel. Conclusion The first cases of pandemic A/H1N1 influenza in Spain were imported by airplane from Mexico. Preventive efforts to reduce the impact of the influenza influenced that primary and secondary rates were lower than first estimations by WHO (AU)

Pandemic A/H1N1 influenza: transmission of the first cases in Spain.

INTRODUCTION: Pandemic A/H1N1 influenza emerged in Mexico at the end of March 2009. Since then, it is still important to provide evidences that contributed to the international spread of the virus and to ascertain the attack rate of this new strain of influenza among the first cases in Spain that led to identify the first transmission in Europe. METHODS: Three pandemic A/H1N1 influenza groups related to an overseas flight were studied: 71 student group, 94 remaining passengers, and 68 contacts of confirmed cases. The attack rate with their 95% confidence interval (CI) among the student group and contacts was calculated. On April 26th, when the first cases were notified, strong preventive measures were implemented among the student group and the contacts of the confirmed cases. RESULTS: On 27th April, the first pandemic A/H1N1 influenza cases confirmed in Spain were three students that came back from Mexico by airplane. A student generated the first native case in Spain and one of the first cases in Europe. Similar attack rates were found between the student group (14.1%; CI: 12.1-16.1) and their contacts (13.2%; CI: 4.4-22.0), but no cases among remaining passengers were detected, suggesting low transmission risk during air travel. CONCLUSION: The first cases of pandemic A/H1N1 influenza in Spain were imported by airplane from Mexico. Preventive efforts to reduce the impact of the influenza influenced that primary and secondary rates were lower than first estimations by WHO.

[Characteristics of cases hospitalized for severe pandemic (H1N1) 2009 in Catalonia]. / Características de los casos graves hospitalizados por gripe pandémica a (H1N1) 2009 en Cataluña.

BACKGROUND: Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU). METHODS: A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model. RESULTS: We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI>40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8). CONCLUSIONS: This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination.

Características de los casos graves hospitalizados por gripe pandémica (H1N1) 2009 en Cataluña / Characteristics of cases hospitalized for severe pandemic (H1N1) 2009 in Catalonia

Fundamentos. Las pandemias de gripe pueden comportar una mayor gravedad. El objetivo fue determinar las características de los casos graves hospitalizados de gripe pandémica en Cataluña y estudiar factores de riesgo de ingreso en UCI. Métodos: Se realizó un estudio epidemiológico observacional y prospectivo de los casos nuevos de gripe pandémica hospitalizados por su gravedad en el período: junio del 2009 hasta mayo del 2010. Se solicitó a los centros sanitarios la declaración de los casos que cumplieron la definición de caso grave y en los que se confirmó la presencia del virus pandémico. Mediante una encuesta epidemiológica se recogió información sobre variables demográficas, clínica, factores de riesgo, tratamiento y evolución clínica. Las diferencias entre los casos en UCI respecto al resto de casos graves se estudiaron con la odds ratio ajustada (ORa) mediante un modelo de regresión logística no condicional. Resultados: Se detectaron 773 casos graves de gripe pandémica; 465 (60,2%) presentaron al menos un factor de riesgo y los más prevalentes fueron: embarazo 19 (13%), asma 87 (12%); enfermedad pulmonar obstructiva crónica 87 (11,4%) y cardiopatías 80 (10,5%). Precisaron ingreso en una unidad de cuidados intensivos 293 pacientes (37,9%). Los factores asociados al ingreso en UCI fueron la obesidad IMC>40 (ORa=2,5; IC 95% 1,4-4,5) y la enfermedad hepática crónica (ORa=2,3; IC 95% 1,1-4,8). Conclusiones: Se confirma la alta prevalencia de embarazo, enfermedades respiratorias crónicas, diabetes y obesidad entre los casos graves. La obesidad mórbida se comporta como un factor de riesgo de ingreso en UCI y por ello debe ser un indicador de vacunación antigripal(AU)

Background. Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU). Methods: A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model. Results: We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI> 40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8). Conclusions: This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination(AU)

Hepatitis A outbreaks in the vaccination era in Catalonia, Spain.

Hepatitis A outbreaks have a major impact on public health services and involve case investigation and intervention measures to susceptible contacts. At the end of 1998 a universal vaccination program with a combined hepatitis A+B vaccine was started in Catalonia (Spain) in 12-years-old preadolescents. The objective of this study was to compare the characteristics of hepatitis A outbreaks in the periods before and after the introduction of the preadolescent vaccination program and to estimate the preventable fraction of cases associated to outbreaks. The incidence rates of outbreaks, cases and hospitalization associated with each outbreak were calculated. Two periods were considered: before (1991-1998) and after (2000-2007) the introduction of mass vaccination. The preventable fraction and 95% confidence intervals (CI) of cases associated with outbreaks was calculated. The rate of associated cases with outbreaks was higher in the period before the vaccination program than in the post vaccination period (1.53 per 100,000 person-year vs 1.12 ; p< 0.001), but the rate of hospitalization was greater in the period after the introduction of vaccination program than in the period previous to vaccination (0.70 per million persons-year vs 0.08; p< 0.001). The preventable fraction of cases associated to outbreaks was 19.6%(95%CI 6.7-32.5) in the 0-4 years group and 16.7% (95% CI 6.0-27.5) in the 5-14 years group, but the highest figure (38.6%; 95%CI 21.3-55.9) was observed in the 15-24 years age group. The estimated proportion of cases associated with outbreaks that would theoretically have been prevented with the vaccination program suggests that substantial benefits have been obtained in Catalonia in people aged less than 25 years.

Epidemiological analysis of severe hospitalized 2009 pandemic influenza A (H1N1) cases in Catalonia, Spain.

From 25th April 2009 to 20th January 2010, 771 laboratory confirmed cases of 2009 pandemic influenza A (H1N1) were admitted to intensive care units (ICU) or hospitalized in medical wards with clinical criteria of severe disease (hospitalized pneumonias, multiorganic failure, septic shock or admitted to ICU or death while hospitalized). 82% of cases were hospitalized between epidemiological week 43 and 48 (25th October - 5th December 2009). Median age of patients was 40 years (range 0-89 years) and 56% were males. 38.7% cases were in the 15-44 year age-group, 29.4% in the 45-64 and 21.8% were children under 15 years of age. 36.8% were admitted to an ICU and 48 died. Underlying conditions were absent in 29% of patients (up to 38% among those under 15 years old). Differences in the prevalence of underlying conditions were found between children and adults. In children less than 15 years old, asthma (16.2%), other respiratory diseases (12.7%), cognitive disorders (10.2%), epilepsy (8.7%) and neuromuscular disorders (7.1%) were the most frequent. In adults, chronic obstructive pulmonary disease (14.8%), cardiovascular diseases (12.6%), asthma (11.5%), diabetes (11.2%) and morbid obesity (10.6%) were the most frequent. Further surveillance is needed to better characterize the epidemiology of this pandemic.

Mumps: a year of enhanced surveillance in Catalonia, Spain.

Mumps is a vaccine-preventable disease candidate for elimination. Positive predictive value (PPV) of clinical case definition was assessed. During 2007, 410 suspected cases were reported in Catalonia: 348 fulfilled clinical case definition and 159 were laboratory confirmed. Incidence rate was 4.8 per 100,000 for cases that fulfilled the clinical definition, and 2.2 for laboratory confirmed cases. Global PPV was 44.5%; 38.5% in <15 years and 50% in > or =15 years (p=0.04). Most laboratory confirmed cases (72.3%) received at least one MMR dose. With sustained high MMR coverage, laboratory confirmation is necessary to control the disease and assess vaccine failure.