Effectiveness of a Meningococcal Group B Vaccine (4CMenB) in Children.

BACKGROUND: In September 2015, the four-component, protein-based meningococcal serogroup B vaccine (4CMenB; Bexsero) became available for private purchase in Spain. METHODS: We conducted a nationwide matched case-control study to assess the effectiveness of 4CMenB in preventing invasive meningococcal disease in children. The study included all laboratory-confirmed cases of invasive meningococcal disease in children younger than 60 months of age between October 5, 2015, and October 6, 2019, in Spain. Each case patient was matched with four controls according to date of birth and province. 4CMenB vaccination status of the case patients and controls was compared with the use of multivariate conditional logistic regression. RESULTS: We compared 306 case patients (243 [79.4%] with serogroup B disease) with 1224 controls. A total of 35 case patients (11.4%) and 298 controls (24.3%) had received at least one dose of 4CMenB. The effectiveness of complete vaccination with 4CMenB (defined as receipt of at least 2 doses, administered in accordance with the manufacturer's recommendations) was 76% (95% confidence interval [CI], 57 to 87) against invasive meningococcal disease caused by any serogroup, and partial vaccination was 54% (95% CI, 18 to 74) effective. Complete vaccination resulted in an effectiveness of 71% (95% CI, 45 to 85) against meningococcal serogroup B disease. Vaccine effectiveness with at least one dose of 4CMenB was 64% (95% CI, 41 to 78) against serogroup B disease and 82% (95% CI, 21 to 96) against non-serogroup B disease. With the use of the genetic Meningococcal Antigen Typing System, serogroup B strains that were expected to be covered by 4CMenB were detected in 44 case patients, none of whom had been vaccinated. CONCLUSIONS: Complete vaccination with 4CMenB was found to be effective in preventing invasive disease by serogroup B and non-serogroup B meningococci in children younger than 5 years of age.

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain.

BACKGROUND: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. METHODS: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. RESULTS: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. CONCLUSIONS: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).

[Epidemiology of Campylobacteriosis in Castile and Leon, Spain,during the period 2008-2015]. / Epidemiología de la campilobacteriosis en Castilla y León durante el período 2008-2015.

OBJECTIVE: Campylobacter is considered the most frequent agent of gastroenteritis in humans all around the world. The aim of this study was to know the incidence, trend and seasonality of notified campylobacteriosis cases in Castile and Leon, Spain, from 2008 to 2015. In addition, to describe the type of case and source of notification, and study the influence of age, sex and Campylobacter species on the hospitalization of cases. METHODS: Retrospective cross-sectional study with a time series analysis. Data on notified campylobacteriosis cases were collected from the Epidemiological Surveillance System of Castile and Leon (2008-2015). Incidence rates and incidence rate ratios by age, sex and year of notification were calculated. In order to estimate trend and seasonality, a time series analysis was performed using a multiplicative method and adjusted to a linear and exponential model. RESULTS: From 4,330 cases analyzed, 49.4% of children aged under 5 were affected. The ratio of men to women was 1.43 and 61.8% of cases were notified from secondary care. C. jejuni was isolated from 72.3% of samples (n=2,593). Incidence rate ranged from 11.42 cases per 100,000 inhabitants in 2008 to 33.53 in 2015. The seasonality range was from 71.97% (13th four-week period) to 125.54% (9th four-week period). Hospitalization reached 62.5% for people aged 60 or over. CONCLUSIONS: A growing trend of notified campylobacteriosis cases is observed in Castile and Leon (2008-2015), mainly in children aged under 5, with a peak in summer months. Males are more affected than females and hospitalization increases with age.

OBJETIVO: El Campylobacter es considerado el agente causal más común en el mundo de gastroenteritis humana. El objetivo de este estudio fue conocer la incidencia, tendencia y estacionalidad de los casos de campilobacteriosis declarados en Castilla y León (periodo 2008-2015) así como describir el tipo de presentación y nivel asistencial de declaración y estudiar la influencia de la edad, sexo y especie de Campylobacter en la hospitalización de las personas afectadas. METODOS: Estudio retrospectivo con análisis de la serie temporal. Los datos se obtuvieron de los casos notificados al Sistema de Vigilancia Epidemiológica de Castilla y León (2008-2015). Para cada año, se hallaron tasas de incidencia y razón de tasas de incidencia globales y por edad y sexo. Se analizó la tendencia y estacionalidad de la serie temporal mediante método multiplicativo, ajustándose a un modelo lineal y exponencial. RESULTADOS: Se analizaron 4.330 casos, con un 49,4% de afectación en menores de 5 años. La ratio hombre/mujer fue 1,43 y un 61,8% de casos se notificó desde atención especializada. C. jejuni se aisló en un 72,3% de muestras (n=2.593). La tasa de incidencia pasó de 11,42 casos por 100.000 habitantes en 2008 a 33,53 en 2015. El índice de estacionalidad varió entre 71,97% (cuatrisemana 13) y 125,54% (cuatrisemana 9). La hospitalización en ≥60 años alcanzó el 62,5%.

Epidemiología de la campilobacteriosis en Castilla y León durante el período 2008-2015 / Epidemiology of campylobacteriosis in Castile and Leon, Spain, during the period 2008-2015

Fundamentos: El Campylobacter es considerado el agente causal más común en el mundo de gastroenteritis humana. El objetivo de este estudio fue conocer la incidencia, tendencia y estacionalidad de los casos de campilobacteriosis declarados en Castilla y León (periodo 2008-2015) así como describir el tipo de presentación y nivel asistencial de declaración y estudiar la influencia de la edad, sexo y especie de Campylobacter en la hospitalización de las personas afectadas. Métodos: Estudio retrospectivo con análisis de la serie temporal. Los datos se obtuvieron de los casos notificados al Sistema de Vigilancia Epidemiológica de Castilla y León (2008-2015). Para cada año, se hallaron tasas de incidencia y razón de tasas de incidencia globales y por edad y sexo. Se analizó la tendencia y estacionalidad de la serie temporal mediante método multiplicativo, ajustándose a un modelo lineal y exponencial. Resultados: Se analizaron 4.330 casos, con un 49,4% de afectación en <5 años. La ratio hombre/mujer fue 1,43 y un 61,8% de casos se notificó desde atención especializada. C. jejuni se aisló en un 72,3% de muestras (n=2.593). La tasa de incidencia pasó de 11,42 casos por 100.000 habitantes en 2008 a 33,53 en 2015. El índice de estacionalidad varió entre 71,97% (cuatrisemana 13) y 125,54% (cuatrisemana 9). La hospitalización en ≥60 años alcanzó el 62,5%. Conclusiones: Se observa una tendencia ascendente de los casos notificados de campilobacteriosis en Castilla y León (2008-2015), especialmente en <5 años, con una clara estacionalidad en verano. Predomina en hombres, y la hospitalización aumenta con la edad (AU)

Background: Campylobacter is considered the most frequent agent of gastroenteritis in humans all around the world. The aim of this study was to know the incidence, trend and seasonality of notified campylobacteriosis cases in Castile and Leon, Spain, from 2008 to 2015. In addition, to describe the type of case and source of notification, and study the influence of age, sex and Campylobacter species on the hospitalization of cases. Methods: Retrospective cross-sectional study with a time series analysis. Data on notified campylobacteriosis cases were collected from the Epidemiological Surveillance System of Castile and Leon (2008-2015). Incidence rates and incidence rate ratios by age, sex and year of notification were calculated. In order to estimate trend and seasonality, a time series analysis was performed using a multiplicative method and adjusted to a linear and exponential model. Results: From 4,330 cases analyzed, 49.4% of children aged under 5 were affected. The ratio of men to women was 1.43 and 61.8% of cases were notified from secondary care. C. jejuni was isolated from 72.3% of samples (n=2,593). Incidence rate ranged from 11.42 cases per 100,000 inhabitants in 2008 to 33.53 in 2015. The seasonality range was from 71.97% (13th fourweek period) to 125.54% (9th four-week period). Hospitalization reached 62.5% for people aged 60 or over. Conclusions: A growing trend of notified campylobacteriosis cases is observed in Castile and Leon (2008-2015), mainly in children aged under 5, with a peak in summer months. Males are more affected than females and hospitalization increases with age (AU)

Brote de tuberculosis resistente a isoniacida en una comunidad de inmigrantes en España / Outbreak of isoniazid-resistant tuberculosis in an immigrant community in Spain

Introducción: La tuberculosis (TB) continúa siendo un importante problema de salud pública. En 2013 se declararon 9 millones de casos nuevos de TB activa a nivel mundial, siendo la proporción de nuevos casos de TB multirresistente del 3,5%. Método: Se realizó un estudio de contactos de un caso de TB pulmonar en una paciente de nacionalidad boliviana. Las pruebas diagnósticas se realizaron según los protocolos establecidos a nivel nacional y local. Resultados: Se detectaron 5 casos a partir del caso índice y se constató la existencia de un brote de TB en una comunidad inmigrante. El resultado del genotipado y del antibiograma ampliado de las muestras de esputo fue crecimiento de Mycobacterium tuberculosis (KatG-msp no mutado/inhA C-T 5RBS) resistente a isoniacida. Se realizó la búsqueda activa de convivientes y contactos con un censo total de 39 personas. La incidencia de infección latente fue de 71,43%. Discusión: El estudio de este brote como otros en la literatura constata la importancia de la búsqueda activa de la localización de contactos y su estudio, de la investigación de laboratorio para lograr la mejora en la detección precoz de la TB. Un diagnóstico precoz del enfermo, el cumplimiento de un tratamiento adecuado y la vigilancia de la farmacorresistencia se consideran pilares fundamentales para la prevención y el control de la TB

Background: Tuberculosis (TB) remains a major public health problem. In 2013, 9 million new cases of active TB were estimated globally and the proportion of reported new cases with multi-drug resistance (MDR) was 3.5%. Methods: Contact tracing of a case of pulmonary tuberculosis was performed in a Bolivian patient. Diagnostic tests were performed according to national and local protocols. Results: An outbreak of tuberculosis in an immigrant community was detected, with 5 cases originating from one index case. Genotyping and drug susceptibility testing of the sputum samples determined Mycobacterium tuberculosis resistant to isoniazid (KatG-msp unmutated/inhA 5RBS CT). Active case finding revealed a total of 39 contacts with an incidence of latent infection of 71.43%. Conclusions: The present study confirms the importance of active case finding through contact tracing as well as rapid laboratory diagnosis to achieve improvements in early detection of TB. Early diagnosis of the patient, compliance with appropriate treatment protocols and monitoring of drug resistance are considered essential for the prevention and control of TB

Outbreak of isoniazid-resistant tuberculosis in an immigrant community in Spain. / Brote de tuberculosis resistente a isoniacida en una comunidad de inmigrantes en España.

BACKGROUND: Tuberculosis (TB) remains a major public health problem. In 2013, 9 million new cases of active TB were estimated globally and the proportion of reported new cases with multi-drug resistance (MDR) was 3.5%. METHODS: Contact tracing of a case of pulmonary tuberculosis was performed in a Bolivian patient. Diagnostic tests were performed according to national and local protocols. RESULTS: An outbreak of tuberculosis in an immigrant community was detected, with 5 cases originating from one index case. Genotyping and drug susceptibility testing of the sputum samples determined Mycobacterium tuberculosis resistant to isoniazid (KatG-msp unmutated/inhA 5RBS CT). Active case finding revealed a total of 39 contacts with an incidence of latent infection of 71.43%. CONCLUSIONS: The present study confirms the importance of active case finding through contact tracing as well as rapid laboratory diagnosis to achieve improvements in early detection of TB. Early diagnosis of the patient, compliance with appropriate treatment protocols and monitoring of drug resistance are considered essential for the prevention and control of TB.

Transmisión nosocomial de la infección gripal / Nosocomial flu infection

No disponible

Gripe (H1N1) 2009 en Castilla y León: estudio de casos dospitalizados y concordancia con los protocolos de actuación desarrollados / Influenza (H1N1) 2009 in Castilla y León: hospitalized care studies and match with the protocols of action developed

Fundamento: En abril del año 2009 la Organización Mundial de la Salud declaró una Emergencia de Salud Pública de Importancia Internacional por la aparición de casos en humanos por un nuevo virus de la gripe A H1N1. El objetivo de este trabajo es analizar las características de los casos investigados y valorar la conformidad de los sujetos estudiados con las indicaciones y recomendaciones de la Consejería de Sanidad de Castilla y León. Métodos: Estudio epidemiológico descriptivo del total de las peticiones de laboratorio solicitadas en Castilla y León, entre las semanas epidemiológicas 44 y 50, ambas inclusive y de los casos que resultaron positivos. Resultados: Se solicitaron 588 peticiones analíticas para gripe A H1N1 (58% hombres). La edad media fue de 34,8 años (27,1% entre 15 y 44 años) y la enfermedad respiratoria crónica el factor de riesgo más frecuente (18,9%). En el 19,1% se instauró tratamiento antiviral (54,5% en las primeras 48 horas). El 42% de las peticiones cumplían criterios de gravedad y el 27,4% de las peticiones fueron positivas (53,4% varones). La edad media en las peticiones positivas fue 34,52 años (33,1% entre 15 y 44 años). En el 26,7% el factor de riesgo más frecuente fue la enfermedad respiratoria crónica, el 6,8% tenía obesidad mórbida. El 28,9% de los sujetos que dieron positivo recibió tratamiento antiviral (61,4% en las primeras 48 horas) y el 47,8% cumplían criterios de gravedad. Conclusión: La mayoría de los casos estudiados no cumplían criterios de gravedad, lo que pone de manifiesto el bajo cumplimiento de los protocolos de vigilancia en el ámbito asistencial(AU)

Background: In April 2009, the World Health Organization declared the emergence of human cases by a new influenza virus H1N1 as a Public Health Emergency of International Importance. Our objective was to analyze the characteristics of the cases investigated and to assess the compliance of the subjects studied with the indications and recommendations of the Health Regional Ministry of Health Castilla y León. Methods: A descriptive epidemiological study of all positive cases and every requests made to Castilla y León, from epidemiological weeks 44 to 50, both included. Results: 588 requests were made to test for influenza A H1N1 (58% males). The mean age was 34.8 years (27.1% between 15 and 44 years). 42% fulfilled criteria for severity. Chronic respiratory disease was the most common risk factor found (18.9%). Antiviral treatment was found in 19.1% (54.5% within the first 48 hours). 27.4% of the requests were positive (53.4% males). The mean age of the positive cases was 34.52 years was positive (33.1% between 15 and 44 years). 47.8% of them fulfilled criteria for severity and chronic respiratory disease was also the most common risk factor found also in the positive (26.7%). Only 6.8% were morbidly obese. 28.9% of positives received antiviral treatment (61.4% within the first 48 hours). Conclusion: Most cases did not fulfil severity criteria, which illustrates the low compliance of monitoring protocols in sanitary care system(AU)

[Influenza (H1N1) 2009 in Castilla y Leon, Spain: hospitalized case studies and match with the protocols of action developed]. / Gripe (H1N1) 2009 en Castilla y León: estudio de casos hospitalizados y concordancia con los protocolos de actuación desarrollados.

BACKGROUND: In April 2009, the World Health Organization declared the emergence of human cases by a new influenza virus H1N1 as a Public Health Emergency of International Importance. Our objective was to analyze the characteristics of the cases investigated and to assess the compliance of the subjects studied with the indications and recommendations of the Health Regional Ministry of Health Castilla y León. METHODS: A descriptive epidemiological study of all positive cases and every requests made to Castilla y León, from epidemiological weeks 44 to 50, both included. RESULTS: 588 requests were made to test for influenza A H1N1 (58% males). The mean age was 34.8 years (27.1% between 15 and 44 years). 42% fulfilled criteria for severity. Chronic respiratory disease was the most common risk factor found (18.9%). Antiviral treatment was found in 19.1% (54.5% within the first 48 hours). 27.4% of the requests were positive (53.4% males). The mean age of the positive cases was 34.52 years was positive (33.1% between 15 and 44 years). 47.8% of them fulfilled criteria for severity and chronic respiratory disease was also the most common risk factor found also in the positive (26.7%). Only 6.8% were morbidly obese. 28.9% of positives received antiviral treatment (61.4% within the first 48 hours). CONCLUSION: Most cases did not fulfil severity criteria, which illustrates the low compliance of monitoring protocols in sanitary care system.