Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study.

BACKGROUND: With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS: National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS: We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS: One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.

Assessment of tuberculosis surveillance by capture–recapture in the Balearic Islands, Spain, 2005–2007 / Evaluación de la vigilancia de tuberculosis por captura-recaptura en las Islas Baleares, España, 2005–2007

The tuberculosis surveillance system in the Balearic Islands was assessed from 2005 to 2007. Applying the capture-recapture method the completeness of this system was evaluated to be 58.4%. When a new electronic recorded data was included in Primary Health Care, up to 66.5% was obtained. This new source of data increased the detected cases of pulmonary tuberculosis from 572 to 681. As a result, the estimated annual incidence rate increases from 18.9 cases/105 to 22.6 cases/105 [95% CI, 20.9-24.3], similar to figures issued by WHO

Evaluamos el sistema de vigilancia de tuberculosis en las islas Baleares desde 2005 a 2007. Aplicando el método captura-recaptura cuantificamos la exhaustividad del sistema en 58.4%. Incluyendo nuevos datos electrónicos registrados en Atención Primaria obtenemos un incremento hasta 66.5%. Ésta nueva fuente de datos incrementa los casos detectados de tuberculosis pulmonar desde 572 a 681. Como resultado, la incidencia anual estimada incrementa desde 18.9 casos/105 hasta 22.6 casos/105 [IC 95%, 20.9-24.3], similar a los cálculos de la OMS

Assessment of tuberculosis surveillance by capture-recapture in the Balearic Islands, Spain, 2005-2007.

The tuberculosis surveillance system in the Balearic Islands was assessed from 2005 to 2007. Applying the capture-recapture method the completeness of this system was evaluated to be 58.4%. When a new electronic recorded data was included in Primary Health Care, up to 66.5% was obtained. This new source of data increased the detected cases of pulmonary tuberculosis from 572 to 681. As a result, the estimated annual incidence rate increases from 18.9 cases/10(5) to 22.6 cases/10(5) [95% CI, 20.9-24.3], similar to figures issued by WHO.

Outbreak of hepatitis A in a nursery school.

In a background of very low incidence of hepatitis A HA in the last decade (annual average of 1.8 cases per 100,000 inhabitants) we describe an outbreak of HA which evolved in Mallorca between May and August 2010, whose main focus was a nursery school where more cases were parents and other young relatives of the children of the institution. Thirty-four cases were defined as outbreak cases. Ten were children of the nursery or their siblings and 22 adults (3 staff members of the nursery and 19 relatives; median age 33 years). The first detected cases were children of the same class. There were 2 adults with haematological complications, though not severe. All children, nursery staff members, parents, and siblings of the cases of the first affected class were immediately offered HA vaccination, but only 43.3% eligible individuals accepted it. None of the cases had been vaccinated. The outbreak spread mostly from asymptomatic children to young adults, showing the changes in HA pattern. That is of great concern as the risk of severe illness rises with age. This incident shows the need to implement new HA vaccination policies in outbreak control. This was later carried out.

Brote escolar de gastroenteritis aguda por Salmonella typhimurium / School outbreak of acute gastroenteritis caused by Salmonella typhimurium

Se produjo un brote de gastroenteritis aguda por Salmonella typhimurium asociado con el consumo de hamburguesas en una escuela de verano, con una elevada tasa de ataque y un alto porcentaje de hospitalizaciones en el grupo de menor edad. Las edades de los niños expuestos oscilaban entre los 8 y los 16 años. Se produjeron 7 casos graves que requirieron ingreso hospitalario. Se propusieron dos hipótesis, que no pudieron ser verificadas, como origen del brote: contaminación en origen o durante el proceso de elaboración, con mayor probabilidad en la trituradora. Los factores causantes del brote podrían haber sido un tiempo excesivo de descongelación, el uso inadecuado de la temperatura, un tratamiento térmico insuficiente y deficiencias en la limpieza y desinfección de la máquina picadora de carne. No se pudo descartar un portador asintomático como origen de la contaminación, ya que no se procedió a la toma de muestras de heces del personal manipulador. La investigación de este brote demuestra la importancia de la colaboración de las propias empresas de alimentación con el departamento de Salud Pública (en este caso a través de la consultoría sanitaria) para conocer el origen del brote y sus posibles factores contribuyentes. Sin embargo, la falta de rigurosidad en los registros de los procesos de autocontrol dificulta la identificación de la fuente de contaminación y las posibles deficiencias en la manipulación o conservación de los alimentos...

An outbreak of cutaneous infection due to Mycobacterium abscessus associated to mesotherapy

Introduction: In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic. Methods Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin. Results Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended. Conclusions The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity (AU)

Introducción: En febrero de 2009 se detectó en Baleares un brote de abscesos subcutáneos causados por Mycobacterium abscessus que afectaba mujeres jóvenes y sanas que se habían sometido a procedimientos de mesoterapia en una clínica de estética. Métodos: Se realizaron investigación epidemiológica, inspección sanitaria y estudios microbiológicos clínicos y ambientales. Los pacientes iniciaron tratamiento antibiótico (según antibiograma) con claritromicinay, en los casos más graves, amikacina. Resultados: Aparecieron lesiones en 17 de las 77 personas sometidas a la mesoterapia en el período de riesgo. Los productos inyectados eran fármacos homeopáticos en multivial. Las muestras ambientales fueron negativas. No se evidenciaron deficiencias en los equipos y procedimientos. Los medicamentos estaban correctamente almacenados y todas las muestras fueron negativas para Mycobacteria, aunque se identificó Paenibacillus provencensis de multiviales precintados y el producto fue retirado de la distribución. Se detectaron deficiencias en la producción de estériles en la fábrica, por lo que la línea de producción fue suspendida y el producto retirado. Conclusiones: Los resultados de la investigación ambiental sugieren que la causa más probable del brote habría sido la contaminación del producto en origen, aunque no fue confirmada por laboratorio. La difusión del uso de productos homeopáticos en procedimientos invasivos requiere un control riguroso durante la fabricación, manipulación y envasado. Es importante considerar la mesoterapia y el uso parenteral de productos homeopáticos como fuentes potenciales de infección y por lo tanto extremar las precauciones y la garantía de calidad de los productos y los procedimientos de la misma manera que con cualquier otro producto farmacológico o actividad médica (AU)

An outbreak of cutaneous infection due to Mycobacterium abscessus associated to mesotherapy.

INTRODUCTION: In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic. METHODS: Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin. RESULTS: Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended. CONCLUSIONS: The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.

Brote de norovirus en Mallorca asociado al consumo de ostras / Norovirus outbreak in Majorca (Spain) associated with oyster consumption

Se describe la investigación de un brote de gastroenteritis por norovirus asociado al consumo de ostras.Se encuestaron 346 expuestos (266 afectados). Solamente se enviaron 14 muestras de heces de pacientes al Centro Nacional de Microbiología. Se mandaron ostras recogidas en el lugar de producción al Centro Nacional de Alimentación. Las ostras cumplían los parámetros microbiológicos de calidad aplicables antes de la comercialización, que no incluyen investigación de virus. El análisis epidemiológico asoció la aparición de la enfermedad al consumo de ostras (odds ratio [OR] = 60,4; intervalo de confianza del 95%[IC95%]: 26,2-139,3) y de navajas (OR = 3,13; IC95%: 1,4-6,9). Los análisis microbiológicos identificaron norovirus en los afectados, pero no en las ostras que habían estado sometidas a un tiempo mayor de depuración que las consumidas. Es necesario un control riguroso de los alimentos de especial riesgo para la transmisión de norovirus y disponer de recursos de laboratorio para investigar brotes alimentarios pornorovirus (AU)

We describe investigation into an outbreak of norovirus gastroenteritis associated with oyster consumption.A survey was conducted in 346 exposed persons, 266 of whom were cases. Only 14 feces samples from patients were sent to the National Microbiology Laboratory. Oysters collected at the production sitewere sent to the National Food Center. The oysters met the microbiological quality standard required before sale, which did not include virus investigation. Epidemiological analysis showed an association between gastroenteritis and consumption of oysters (OR = 60.4; 95% CI: 26.2-139.3) and razor shells(OR = 3.13; 95% CI: 1.4-6.9). Microbiological analysis confirmed norovirus in affected individuals but not in the oysters that had been tested after a longer purification period than those consumed. Food with aspecial risk of norovirus transmission should be strictly monitored. Investigators should dispose of the necessary laboratory resources to study food-borne norovirus outbreaks (AU)

[Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007]. / Vigilancia de la tuberculosis en las Islas Baleares y caracterización de los casos infradeclarados entre los años 2005 y 2007.

We performed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance System in the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported cases in sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosis was approximately 20%. Significant factors in multivariate analysis were social marginality (consisting of alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR: 3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengthening notification by hospital specialists through the use of hospital electronic records. Our findings show that the information obtained from the primary care computerized history is helpful in improving the epidemiological surveillance of tuberculosis.

[Norovirus outbreak in Majorca (Spain) associated with oyster consumption]. / Brote de norovirus en Mallorca asociado al consumo de ostras.

We describe investigation into an outbreak of norovirus gastroenteritis associated with oyster consumption. A survey was conducted in 346 exposed persons, 266 of whom were cases. Only 14 feces samples from patients were sent to the National Microbiology Laboratory. Oysters collected at the production site were sent to the National Food Center. The oysters met the microbiological quality standard required before sale, which did not include virus investigation. Epidemiological analysis showed an association between gastroenteritis and consumption of oysters (OR = 60.4; 95% CI: 26.2-139.3) and razor shells (OR = 3.13; 95% CI: 1.4-6.9). Microbiological analysis confirmed norovirus in affected individuals but not in the oysters that had been tested after a longer purification period than those consumed. Food with a special risk of norovirus transmission should be strictly monitored. Investigators should dispose of the necessary laboratory resources to study food-borne norovirus outbreaks.

Vigilancia de la tuberculosis en las Islas Balearesy caracterización de los casos infradeclarados entre los a˜nos 2005 y 2007 / Tuberculosis surveillance in the Balearic Islands and characteristics of unreported cases from 2005 to 2007

Estudio descriptivo de los casos de tuberculosis detectados por el Sistema de Vigilancia Epidemiológicaen Baleares, en el trienio de 2005 a 2007. El objetivo fue caracterizar los casos infradeclarados en términossociodemográficos y de su contacto con la atención primaria de salud. Globalmente, la infradeclaraciónde la tuberculosis se sitúa en torno al 20%. Las características que resultan significativas en el análisismultivariado son la marginalidad social (alcoholismo, usuarios de drogas por vía parenteral o indigencia)(odds ratio ajustada [ORa] : 2,6 [1,2-5,3]), el contacto con la atención primaria (ORa : 3,2 [1,4-7,1]) y latuberculosis extrapulmonar (ORa : 5,5 [3,2-9,6]). Se recomienda reforzar la notificación de los especialistashospitalarios mediante la adecuación informática de la historia clínica hospitalaria, y se observa quela información obtenida desde la informatización de la historia en atención primaria resulta de utilidadpara mejorar la vigilancia epidemiológica de la tuberculosis (AU)

Weperformed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance Systemin the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported casesin sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosiswas approximately 20%. Significant factors in multivariate analysis were social marginality (consistingof alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR:3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengtheningnotification by hospital specialists through the use of hospital electronic records. Our findings showthat the information obtained from the primary care computerized history is helpful in improving theepidemiological surveillance of tuberculosis (AU)

Brote de gripe por virus pandémico (H1N1) 2009 en una residencia para personas discapacitadas psíquicas en las Islas Baleares / Outbreak of pandemic virus (H1N1) 2009 in a residence for mentally disable persons in balearic island, Spain

Fundamento: La temporada gripal 2009-2010 ha sido más corta y benigna de lo esperado. Desde enero de 2010 los sistemas de vigilancia de gripe indicaban unas tasas de incidencia muy bajas sin detección de circulación del virus. En este contexto, un hospital comunicó una sospecha de brote de enfermedad respiratoria grave, cuya etiología resultó ser gripe (H1N1) 2009. Describimos el brote y las actuaciones de Salud Pública para su control. Métodos: Estudio descriptivo de un brote epidémico por virus gripal pandémico en una residencia para discapacitados mentales. Establecimiento de vigilancia activa. La definición de caso de gripe fue muy sensible para detectar los nuevos casos al inicio, tratarlos precozmente y minimizar la transmisión. Se adoptaron medidas de contención de la infección por virus gripal. Resultados: De 38 casos detectados 7 (todos con factores de riesgo) sufrieron complicaciones graves. No hubo defunciones. La tasa global de ataque fue del 35,2%. Los primeros casos eran trabajadores. Los casos en residentes se acumularon en el pico del brote y entre trabajadores la presentación fue más dispersa. Ninguno de los trabajadores y sólo tres residentes habían sido vacunados. Conclusiones: El brote se inició en los trabajadores de la residencia, a partir de los cuales se difundió a las personas residentes. Destacamos la necesidad de cumplir las recomendaciones de vacunación, no sólo de las personas con factores de riesgo, sino también muy especialmente de los trabajadores en contacto con aquellos(AU)

Background: The flu season 2009-2010 has been shorter and less severe than expected. Since January 2010, influenza surveillance systems indicated rates of very low incidence of influenza without detection of virus circulation. In this context, a hospital reported a suspected outbreak of severe respiratory disease, the aetiology proved influenza A(H1N1)v. Wedescribe the outbreak and public health measures for their control. Methods: Descriptive study of an outbreak of pandemic influenza virus in a residency home for mentally disabled. Establishment of active surveillance. The case definition of influenza was very sensitive to detect new cases early, treated early and minimize transmission. Steps were taken to contain the influenza virus infection Results: Among 38 cases detected 7 had serious complica-tions(all of them with risk factors) . There were no deaths. The overall attack rate was 35.2%. The first cases were workers. The residents were ill at the peak of the outbreak, and among workers the presentation was more dispersed. None of the workers and only three of residents had been vaccinated. Conclusions: Workers possibly have initiated and contributed to the maintenance of transmission. We emphasize the need to comply with vaccination recommendations, not just those with risk factors, but particularly for workers in contact with those(AU)

[Outbreak of pandemic virus (H1N1) 2009 in a residence for mentally disabled persons in Balearic Island, Spain]. / Brote de gripe por virus pandémico (H1N1) 2009 en una residencia para personas discapacitadas psíquicas en las Islas Baleares.

BACKGROUND: The flu season 2009-2010 has been shorter and less severe than expected. Since January 2010, influenza surveillance systems indicated rates of very low incidence of influenza without detection of virus circulation. In this context, a hospital reported a suspected outbreak of severe respiratory disease, the aetiology proved influenza A(H1N1)v. We describe the outbreak and public health measures for their control. METHODS: Descriptive study of an outbreak of pandemic influenza virus in a residency home for mentally disabled. Establishment of active surveillance. The case definition of influenza was very sensitive to detect new cases early, treated early and minimize transmission. Steps were taken to contain the influenza virus infection. RESULTS: Among 38 cases detected 7 had serious complications(all of them with risk factors). There were no deaths. The overall attack rate was 35.2%. The first cases were workers. The residents were ill at the peak of the outbreak, and among workers the presentation was more dispersed. None of the workers and only three of residents had been vaccinated. CONCLUSIONS: Workers possibly have initiated and contributed to the maintenance of transmission. We emphasize the need to comply with vaccination recommendations, not just those with risk factors, but particularly for workers in contact with those.

Recourse to induced abortion in Spain: profiling of users and the influence of migrant populations

Background: Social vulnerability implies a higher risk of induced abortion (IA). Immigrant status could be an additional factor. The objective was to identify the patterns surrounding which women resort to IAs, and to study the relationship between socio-economic and health system factors. Another aim was to determine the relationship between the patterns identified and the immigrant's country. Methods: A cross-sectional study was performed including all IAs notified during 2006 on women residing in three Spanish autonomous communities (the Balearic Islands, Catalonia and Comunitat Valenciana). We used sociodemographic, nationality and related variables, reproductive history and use of health services. A Categorical Principal Component Analysis was used to summarize the information and to identify profiles. Results: More than a third of IAs were performed on non-Spanish women. Four dimensions have been determined that define the profile of women resorting to IAs: age, reproductive history and marital status; type of health services used; social level; and earlier or late IA and its repetitive use. Age and related factors were important determinants. Economic status and knowledge of the health system were related to access to contraception and IA information. Spanish, Western European and South American women had a higher social level than Romanian and African women. Late IA use and a lower recurrence characterised Asian, North African and Spanish women. Conclusion: Differences on IA use between groups of different women seem to be related to vulnerability (economic, social, knowledge and use of healthcare services). There is a different situation among immigrants of differing nationalities (AU)

Objetivos: La vulnerabilidad social representa un riesgo de interrupción voluntaria del embarazo (IVE). La inmigración puede ser un factor adicional. Se pretendía identificar patrones que caracterizaran a las mujeres que abortan y estudiar la relación con factores socioeconómicos y de atención sanitaria. Otro objetivo fue determinar la relación entre los patrones identificados y el origen de las inmigrantes. Métodos: Se realizó un estudio transversal incluyendo todas las IVE notificadas durante 2006 a tres registros de IVE de comunidades autónomas: Illes Balears, Catalunya y Comunitat Valenciana. Se utilizaron variables sociodemográficas, de nacionalidad y relacionadas, historia reproductiva y de utilización de servicios sanitarios. Se realizó un análisis de componentes principales categórico para resumir la información e identificar perfiles. Resultados: Las inmigrantes representaron más de un tercio de las IVE. Cuatro dimensiones definieron el perfil de las mujeres que abortan: edad, historia reproductiva y estado civil; utilización de servicios públicos o privados; nivel social; IVE tardía o precoz y su recurrencia. Edad y factores relacionados fueron determinantes importantes. El nivel económico y el conocimiento del sistema sanitario estaban relacionados con el acceso a la anticoncepción y a la información sobre IVE. Españolas, europeas occidentales y latinoamericanas tenían mayor nivel social que rumanas y africanas. El uso tardío de la IVE y una menor recurrencia fue característico de españolas, norteafricanas y asiáticas. Conclusión: Las diferencias en el recurso a la IVE entre grupos de mujeres parecen relacionarse con la vulnerabilidad (económica, social, de conocimiento y uso del sistema sanitario). La situación varía entre inmigrantes de diferentes nacionalidades (AU)

Recourse to induced abortion in Spain: profiling of users and the influence of migrant populations.

BACKGROUND: Social vulnerability implies a higher risk of induced abortion (IA). Immigrant status could be an additional factor. The objective was to identify the patterns surrounding which women resort to IAs, and to study the relationship between socio-economic and health system factors. Another aim was to determine the relationship between the patterns identified and the immigrant's country. METHODS: A cross-sectional study was performed including all IAs notified during 2006 on women residing in three Spanish autonomous communities (the Balearic Islands, Catalonia and Comunitat Valenciana). We used sociodemographic, nationality and related variables, reproductive history and use of health services. A Categorical Principal Component Analysis was used to summarize the information and to identify profiles. RESULTS: More than a third of IAs were performed on non-Spanish women. Four dimensions have been determined that define the profile of women resorting to IAs: age, reproductive history and marital status; type of health services used; social level; and earlier or late IA and its repetitive use. Age and related factors were important determinants. Economic status and knowledge of the health system were related to access to contraception and IA information. Spanish, Western European and South American women had a higher social level than Romanian and African women. Late IA use and a lower recurrence characterised Asian, North African and Spanish women. CONCLUSION: Differences on IA use between groups of different women seem to be related to vulnerability (economic, social, knowledge and use of healthcare services). There is a different situation among immigrants of differing nationalities.

Guía de principios y métodos de las redes centinelas sanitarias en España / Guide to the principles and methods of health sentinel networks in Spain

Las redes centinelas sanitarias son cada vez más utilizadas en el estudio de problemas relacionados con la salud. Este documento tiene como objetivo la presentación de una guía metodológica para la instauración y desarrollo de redes centinelas sanitarias, que ha sido elaborada por gestores de las redes centinelas autonómicas a partir de los resultados obtenidos de un estudio Delphi. Los principales apartados recogidos en la guía son: definición de una red centinela sanitaria; descripción de la red –objetivos y composición–; modo de selección de los centinelas participantes; descripción de los procesos de salud adecuados para su estudio mediante esta metodología –incidencia, definición de casos, criterios de inclusión y exclusión–; descripción de la población diana; establecimiento de indicadores de calidad; periodicidad de la recogida de datos; diffusion de la información –periodicidad y métodos–, e incorporación de los participantes en los órganos de decisión a través de comisiones multidisciplinarias. La guía tiene como fin contribuir al desarrollo de redes con una metodología común en las diferentes comunidades autónomas. Asimismo, se considera de gran utilidad contar con un modelo para la implantación de nuevas redes en nuestro país. Por último, se concluye que es importante dar a conocer el concepto de red centinela sanitaria, difundir la información que generan y potenciar su uso desde la Administración (AU)

Health sentinel networks are being increasingly used in the study of health-related problems. The present article aims to provide a methodological guide – designed by regional sentinel network managers and based on the results of a Delphi study – that can be used to set up and develop a health sentinel network. The main topics in the guide are the following: definition of a health sentinel network; network description: aims and structure; methods for the selection of sentinel participants; description of health processes suitable for study through this methodology: incidence, case definition, exclusion and inclusion criteria; description of the target population: the denominator for incidence rates estimates; quality indicators; periodicity of data collection; dissemination of the information: periodicity and methods, and incorporation of the participants in the decision- making process through multidisciplinary commissions. This guide aims to contribute to the development of sentinel networks in the autonomous communities by providing a common methodology, which could be highly useful when introducing new networks in Spain. Finally, we conclude that it is important to raise awareness of the concept of health sentinel networks, disseminate the information generated, and promote its use by public health administration (AU)

Redes centinela sanitarias en España. Consenso para una guía de principios y métodos / Health sentinel networks in Spain. Consensus for a guide of principles and methods

Las redes centinela sanitarias han estado activas en nuestro país desde la década de los años ochenta, con variados objetivos, metodología y diferente grado de desarrollo en las comunidades autónomas donde se han implantado. La necesidad de normalizar el funcionamiento y de armonizar los indicadores ha propiciado un proyecto de investigación de redes centinela sanitarias españolas, uno de cuyos objetivos es establecer una guía de principios y métodos de trabajo. Se ha procedido a realizar un estudio con el método Delphi, en el que un panel de 23 expertos ha consensuado, en 3 fases consecutivas, la definición de red centinela, los objetivos, los principios que deben regirlas y otros aspectos relacionados con la organización y funcionamiento. En conjunto se plantearon 41 cuestiones sobre la base de un primer borrador, las cuales necesitaban un 80% de consenso en una primera fase y un 70% en la segunda. Todos los expertos participaron en la primera fase, 22 en la segunda y 20 en la tercera. Se alcanzó un consenso en 36 cuestiones en la primera fase y en 4 de las 5 restantes en la segunda. En la tercera fase se dio forma definitiva al documento de la guía. El método de consenso Delphi ha resultado extremadamente útil en la resolución de discrepancias y divergencias, obteniéndose una guía válida para redes centinela. Los expertos ajenos a los sistemas centinela del panel seleccionado aportaron una visión más extensa sobre los objetivos y la aplicabilidad de las redes centinela sanitarias en España

Since the eighties, health sentinel networks have been active in our country, but with a variety of objectives, methods and different development levels in the autonomous communities. The necessity of standardising the management and harmonising the indicators has concluded in a research project on the Spanish health sentinel networks, one of whose objectives is to establish a guide for work principles and methods. A panel of 23 experts has made a study using the Delphi method to agree, in three consecutive phases, a definition of sentinel network, the objectives and the management principles and other aspects related to the organisation and functioning. Altogether, 41 questions were gathered from a previous draft which needed 80% of consensus in the first phase and 70% in the second. All the experts participated in the first phase, 22 in the second and 20 in the third. A consensus was achieved on 36 questions in the first phase and in 4 of the remaining ones in the second. In the third phase the shape of the guide document was given. The Delphi consensus method has been extremely useful in the resolution of discrepancies and divergences. The experts who were selected outside of the sentinel networks contributed with a wider vision on the objectives and applicability of the health sentinel networks in Spain

[Health sentinel networks in Spain. Consensus for a guide of principles and methods]. / Redes centinela sanitarias en España. Consenso para una guía de principios y métodos.

Since the eighties, health sentinel networks have been active in our country, but with a variety of objectives, methods and different development levels in the autonomous communities. The necessity of standardising the management and harmonising the indicators has concluded in a research project on the Spanish health sentinel networks, one of whose objectives is to establish a guide for work principles and methods. A panel of 23 experts has made a study using the Delphi method to agree, in three consecutive phases, a definition of sentinel network, the objectives and the management principles and other aspects related to the organisation and functioning. Altogether, 41 questions were gathered from a previous draft which needed 80% of consensus in the first phase and 70% in the second. All the experts participated in the first phase, 22 in the second and 20 in the third. A consensus was achieved on 36 questions in the first phase and in 4 of the remaining ones in the second. In the third phase the shape of the guide document was given. The Delphi consensus method has been extremely useful in the resolution of discrepancies and divergences. The experts who were selected outside of the sentinel networks contributed with a wider vision on the objectives and applicability of the health sentinel networks in Spain.

[Guide to the principles and methods of health sentinel networks in Spain]. / Guía de principios y métodos de las redes centinelas sanitarias en España.

Health sentinel networks are being increasingly used in the study of health-related problems. The present article aims to provide a methodological guide - designed by regional sentinel network managers and based on the results of a Delphi study - that can be used to set up and develop a health sentinel network. The main topics in the guide are the following: definition of a health sentinel network; network description: aims and structure; methods for the selection of sentinel participants; description of health processes suitable for study through this methodology: incidence, case definition, exclusion and inclusion criteria; description of the target population: the denominator for incidence rates estimates; quality indicators; periodicity of data collection; dissemination of the information: periodicity and methods, and incorporation of the participants in the decision-making process through multidisciplinary commissions. This guide aims to contribute to the development of sentinel networks in the autonomous communities by providing a common methodology, which could be highly useful when introducing new networks in Spain. Finally, we conclude that it is important to raise awareness of the concept of health sentinel networks, disseminate the information generated, and promote its use by public health administration.

[Estimating the coverage of systematic vaccinations among the Balearic Island infant population]. / Estimación de la cobertura de las vacunaciones sistemáticas en la población infantil de las Islas Baleares.

BACKGROUND: In order for vaccination programs to be carried out properly, it is essential for the vaccination coverage to be known. On the Balearic Islands, the reported coverage was much less than for the rest of Spain. The objective of this study is that of estimating the coverage of the vaccinations included on the recommended schedule up to 18 months of age (4 doses of oral polio, tetanus and diphtheria; 3 doses of whooping cough; 1 dose of measles, rubella and mumps). METHODS: A descriptive, cross-sectional study of the population base. The ideal-time frequency distribution estimators and the corresponding confidence intervals were calculated at 95% (CI95%) for a sample of the resident two-year-old (born in 1995) Balearic Island population selected by means of a single-stage conglomerate random sampling based on census sections. The National Public Health System and National Health Institute vaccination records were reviewed, the data from the vaccination document having been requested from the families and the clinical record from the private pediatricians by telephone. RESULTS: The sample included 606 children, it having been possible to obtain full information on 532 children. Full information was obtained on 377 cases (62%) from the public health sector records. The least degree of coverage was found for the diphtheria vaccine, 518 children having been fully vaccinated, 96.8% (CI95% = 94.8-98.1), the highest degree of coverage having been found for the whooping cough vaccine, 537 children, 98.9% (CI95% = 97.5-99.5). CONCLUSIONS: Good vaccination coverage was found to exist on the Balearic Islands, being similar to what has been being estimated for Spain as a whole. The objective included within the Polio Eradication Plan is accomplished, very little information being gathered from the public sector.