Commercial real time PCR implementation for rapid diagnosis of onychomycosis: A new workflow in a clinical laboratory.

INTRODUCTION: Onychomycosis is a frequent and underdiagnosed condition. Approximately 90% of toenail onychomycosis infections are caused by dermatophytes, but classical diagnosis based on culture and microscopy observation is slow and has low sensitivity. Both limitations can be solved incorporating molecular techniques to routine diagnosis of onychomycosis. OBJECTIVE: Prospective evaluation of the utility of incorporating in the clinical laboratory workflow a commercial real time PCR (qPCR) for dermatophytes detection in nails after potassium hydroxide direct observation screening. MATERIALS AND METHODS: 152 nail samples were included (34 KOH negative and 118 KOH positive) and processed by culture and qPCR. RESULTS: In the negative KOH group, only one dermatophyte grew in culture and three were detected by qPCR. In the group of positive KOH, 57 dermatophytes grew in culture and 81 were detected by qPCR. In this group, 25% of diagnosed dermatophytes were detected only by qPCR. The sensitivity of qPCR compared to culture is 92.8% and time of response decreases from days to hours. CONCLUSION: Based in our results, we propose a workflow algorithm for a clinical laboratory that eliminates culture for qPCR positive samples.

PCR a tiempo real comercial para diagnóstico rápido de las onicomicosis: un nuevo algoritmo de trabajo en el laboratorio clínico / Commercial real time PCR implementation for rapid diagnosis of onychomycosis: A new workflow in a clinical laboratory

Introduction: Onychomycosis is a frequent and underdiagnosed condition. Approximately 90% of toenail onychomycosis infections are caused by dermatophytes, but classical diagnosis based on culture and microscopy observation is slow and has low sensitivity. Both limitations can be solved incorporating molecular techniques to routine diagnosis of onychomycosis. Objective: Prospective evaluation of the utility of incorporating in the clinical laboratory workflow a commercial real time PCR (qPCR) for dermatophytes detection in nails after potassium hydroxide direct observation screening. Materials and methods: 152 nail samples were included (34 KOH negative and 118 KOH positive) and processed by culture and qPCR. Results: In the negative KOH group, only one dermatophyte grew in culture and three were detected by qPCR. In the group of positive KOH, 57 dermatophytes grew in culture and 81 were detected by qPCR. In this group, 25% of diagnosed dermatophytes were detected only by qPCR. The sensitivity of qPCR compared to culture is 92.8% and time of response decreases from days to hours. Conclusion: Based in our results, we propose a workflow algorithm for a clinical laboratory that eliminates culture for qPCR positive samples.(AU)

Introducción: La onicomicosis es una patología frecuentemente infradiagnosticada. Aproximadamente el 90% de las infecciones en las uñas del pie están causadas por dermatofitos, pero el diagnóstico microbiológico clásico basado en cultivo y microscopia es lento y tiene una baja sensibilidad. Ambas limitaciones pueden resolverse incorporando técnicas moleculares al diagnóstico de la onicomicosis. Objetivo: Evaluación prospectiva de la utilidad de incorporar en un laboratorio clínico una PCR a tiempo real (qPCR) comercial para detección de dermatofitos en uñas tras cribado por examen directo con hidróxido de potasio (KOH). Materiales y métodos: Se incluyeron 152 muestras de uñas (34 KOH negativas y 118 KOH positivas) y se procesaron mediante cultivo y qPCR. Resultados: En el grupo KOH negativo, solo un dermatofito creció en cultivo y 3 se detectaron mediante qPCR. En el grupo KOH positivo, 57 dermatofitos crecieron en cultivo y 81 se detectaron por qPCR. En este grupo, el 25% de los dermatofitos diagnosticados se detectaron únicamente mediante qPCR. La sensibilidad de la qPCR comparada con el cultivo es del 92,8% y el tiempo de respuesta disminuye de días a horas. Conclusión: En base a nuestros resultados, proponemos un algoritmo de flujo de trabajo para los laboratorios de microbiología clínica, que elimina el cultivo para aquellas muestras con qPCR positiva.(AU)

Legionella pneumophila recurrently isolated in a Spanish hospital: Two years of antimicrobial resistance surveillance.

OBJECTIVES: The aim of this study was to monitor the spread, persistence and antibiotic resistance patterns of Legionella spp. strains found in a hospital water distribution system. These environmental studies are intended to help detect the presence of antibiotic resistant strains before they infect patients. METHODS: Antimicrobial surveillance tests were performed at 27 different sampling points of the water network of a large Spanish hospital over two years. Water samples were screened for Legionella according to ISO 11731:2007. Legionella spp. isolates were identified by serotyping and by mass spectrometry (MALDI-ToF). Epidemiological molecular typing was done by Pulse-Field Gel Electrophoresis (PFGE) and by Sequence-Based Typing (SBT). Antibiotic susceptibility tests were performed using disk diffusion and ETEST®. RESULTS: Legionella spp. were recurrently isolated for 2 years. All isolates belonged the same group, L. pneumophila serogroups 2-14. Isolates were all attributed by SBT to sequence type (ST) ST328, although PFGE revealed 5 different patterns. No significant change in antibiotic susceptibility could be observed for this study period, irrespectively of the method used. CONCLUSION: Colonization of water systems by Legionella spp. is still occurring, although all the prevention rules were strictly followed. Antibiotic resistance monitoring may help us to find resistance in bacteria with environmental reservoirs but difficult to isolate from patients. The knowledge of the antibiotic susceptibility in environmental strains may help us to predict changes in clinical strains. This study might also help reconsidering Legionnaires' disease (LD) diagnostic methods. L. pneumophila serogroups 2-14 present all along the time of the investigation in the water distribution system can cause LD. However, they may not be detected by routine urine tests run on patients, thereby missing an ongoing LD infection.

Escasa eficacia de metronidazol en la erradicación de Blastocystis hominis en pacientes sintomáticos: serie de casos y revisión sistemática de la literatura / Low efficacy of metronidazole in the eradication of Blastocystis hominis in symptomatic patients: Case series and systematic literature review

Introducción: El Blastocystis hominis (B. hominis) es un protozoo comúnmente encontrado en el tracto gastrointestinal. Existen dudas sobre su significado clínico. El metronidazol (MTZ) es el tratamiento aconsejado de primera línea. Material y métodos: Se realizó una revisión retrospectiva entre 2011 y 2012. Se seleccionaron de forma aleatoria 151 de 383 muestras positivas para B. hominis. Los criterios de inclusión fueron: clínica sugestiva, indicación de tratamiento y realización de control microbiológico. Se realizó una revisión sistemática de los estudios que evalúan el efecto de MTZ sobre la infestación por B. hominis. Resultados: Cuarenta y seis pacientes cumplían criterios de inclusión (el 64% eran mujeres; edad, 44,2±2 años). Se utilizó MTZ en 39 pacientes, de los cuales 31 obtuvieron respuesta clínica (79,5%) pero solo 15 respuesta microbiológica (48,4%). No se apreció una relación dosisefecto. Veinte pacientes sin respuesta microbiológica inicial recibieron una segunda tanda de tratamiento (MTZ, cotrimoxazol, paramomicina, otros), con una respuesta microbiológica del 70%. De forma global, se consiguió la curación de B. hominis en un 72% (IC95%: 57-83%). De 54 tratamientos asociados a respuesta clínica, se produjo respuesta microbiológica en 31 (57%); mientras que de los 12 que se siguieron de ausencia de respuesta clínica solo se observó la curación microbiológica en 2 (17%) (p = 0,022). La tasa de erradicación en la revisión sistemática osciló entre 0 y 100%. Conclusiones: Parece existir relación entre la respuesta clínica y microbiológica al tratamiento de B. hominis. En nuestro entorno geográfico la respuesta microbiológica al tratamiento con MTZ es insuficiente. La revisión sistemática muestra que la respuesta a MTZ es muy variable (AU)

Introduction: Blastocystis hominis (B. hominis) is a protozoan commonly found in the gastrointestinal tract. There are doubts about its clinical significance. Metronidazole (MTZ) is the recommended first-line treatment. Materials and methods: A retrospective review was carried out between 2011 and 2012. A total of 151 samples were randomly selected from 383 samples positive for B. hominis. Inclusion criteria were: suggestive symptoms, treatment indication and microbiological follow-up. A systematic review was performed of all studies that evaluated the effect of MTZ on B. hominis infection. Results: Forty-six patients met the inclusion criteria (64% women; age, 44.2±2 years). MTZ was used in 39 patients, 31 of whom obtained a clinical response (79.5%) but only 15 a microbiological response (48.4%). No dose-effect relationship was observed. Twenty patients with no initial microbiological response received a second round of treatment (MTZ, cotrimoxazole, paramomycin, others), with a microbiological response in 70%. Overall, B. hominis was cured in 72% (95% CI: 57%-83%). Of 54 treatments associated with a clinical response, a microbiological response occurred in 31 (57%), while in the remaining 12 with no clinical response, microbiological cure was observed in only 2 (17%) (P = .022). The eradication rate in the systematic review varied between 0% and 100%. Conclusions: There seems to be a relationship between the clinical and microbiological response to B. hominis treatment. The microbiological response to MTZ treatment is insufficient in our geographical setting. The systematic review shows that the response to MTZ is very variable (AU)

Low efficacy of metronidazole in the eradication of Blastocystis hominis in symptomatic patients: Case series and systematic literature review. / Escasa eficacia de metronidazol en la erradicación de Blastocystis hominis en pacientes sintomáticos: serie de casos y revisión sistemática de la literatura.

INTRODUCTION: Blastocystis hominis (B. hominis) is a protozoan commonly found in the gastrointestinal tract. There are doubts about its clinical significance. Metronidazole (MTZ) is the recommended first-line treatment. MATERIALS AND METHODS: A retrospective review was carried out between 2011 and 2012. A total of 151 samples were randomly selected from 383 samples positive for B. hominis. Inclusion criteria were: suggestive symptoms, treatment indication and microbiological follow-up. A systematic review was performed of all studies that evaluated the effect of MTZ on B. hominis infection. RESULTS: Forty-six patients met the inclusion criteria (64% women; age, 44.2±2 years). MTZ was used in 39 patients, 31 of whom obtained a clinical response (79.5%) but only 15 a microbiological response (48.4%). No dose-effect relationship was observed. Twenty patients with no initial microbiological response received a second round of treatment (MTZ, cotrimoxazole, paramomycin, others), with a microbiological response in 70%. Overall, B. hominis was cured in 72% (95% CI: 57%-83%). Of 54 treatments associated with a clinical response, a microbiological response occurred in 31 (57%), while in the remaining 12 with no clinical response, microbiological cure was observed in only 2 (17%) (P=.022). The eradication rate in the systematic review varied between 0% and 100%. CONCLUSIONS: There seems to be a relationship between the clinical and microbiological response to B. hominis treatment. The microbiological response to MTZ treatment is insufficient in our geographical setting. The systematic review shows that the response to MTZ is very variable.

Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study.

The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.

Encuesta de las medidas de control de Staphylococcus aureusresistente a meticilina en los hospitales que participan en el programa VINCat / Survey of methicillin-resistant Staphylococcus aureus control measures in hospitals participating in the VINCat program

INTRODUCCIÓN: VINCat es un programa de vigilancia de la infección nosocomial en los hospitales de Cataluña. El objetivo del estudio fue evaluar el cumplimiento de las medidas de control de Staphylococcus aureus resistente a meticilina (SARM) en dichos centros. MÉTODOS: De enero a marzo de 2013 se realizó una encuesta por correo sobre las características de los hospitales y la aplicación de las medidas de control de SARM. RESULTADOS: Respondieron 53 hospitales (>500 camas: 7; 200-500 camas: 14;<200 camas: 32; tenían UCI: 29). Disponían de alerta informática de reingresos el 63%. Realizaban vigilancia activa de los traslados de otro hospital el 46,2%, o centro de larga estancia el 55,8%, siendo ambas medidas significativamente más frecuentes en hospitales con una tasa de SARM≤22% (mediana global). Observaban el cumplimento de higiene de manos el 77,4% de los centros y fue mayor al 50% en el 69,7%. Todos los hospitales aplicaban precauciones de contacto, aunque el 62,3% no disponían de material clínico de uso frecuente exclusivo. La limpieza de la habitación se realizaba más frecuentemente en el 54,7% y tenían programas de adecuación del uso de antibióticos el 67,9%. CONCLUSIONES: Este estudio informa sobre la implementación de medidas preventivas de SARM en hospitales del programa VINCat. Aunque la mayoría de los hospitales disponen de un protocolo específico, el cumplimento de las medidas es mejorable, especialmente la detección activa en pacientes de riesgo, la adherencia a la higiene de manos, la limpieza más frecuente de la habitación y la optimización del uso de antibióticos

INTRODUCTION: VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres. METHODS: An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA. RESULTS: A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;<200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA≤22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics. CONCLUSIONS: This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics

[Survey of methicillin-resistant Staphylococcus aureus control measures in hospitals participating in the VINCat program]. / Encuesta de las medidas de control de Staphylococcus aureus resistente a meticilina en los hospitales que participan en el programa VINCat.

INTRODUCTION: VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres. METHODS: An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA. RESULTS: A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;<200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA≤22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics. CONCLUSIONS: This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics.

Aspectos epidemiológicos y carga asistencial de gastroenteritis agudas por Campylobacter y Salmonella / Campylobacter and Salmonella acute gastroenteritis: Epidemiology and health care utilization

Fundamento y objetivo: En Cataluña, los sistemas de notificación y vigilancia no permiten conocer la incidencia real ni la carga asistencial de las gastroenteritis agudas (GEA) bacterianas de origen alimentario por Campylobacter ySalmonella, objeto de este estudio. Pacientes y métodos: Estudio descriptivo de los casos de GEA por Campylobacter y Salmonella en los años 2002 y 2012 en una región de Cataluña, España, identificados a partir de cultivos microbiológicos. Resultados: La incidencia estimada de GEA por Salmonella se redujo un 50% en 2012, y la de Campylobacter, un 20%. Los niños entre 1-4 años fueron los más afectados en ambos períodos. Se observaron diferencias significativas según el microorganismo en la presentación clínica de algunos síntomas y en la duración de la enfermedad. Acudieron al Servicio de Urgencias el 63,7% de los casos, y un 15% requirieron hospitalización, siendo más frecuente entre los casos de salmonelosis. Conclusión: La incidencia de GEA por Campylobacter y Salmonella se ha reducido, pero continúa siendo importante, como lo es la carga asistencial para ambas infecciones. El control de estas dolencias requiere una mayor adecuación de los actuales sistemas de vigilancia epidemiológica (AU)

Background and objective: In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. Patients and methods: Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. Results: The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed betweenCampylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. Conclusion The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections (AU)

[Campylobacter and Salmonella acute gastroenteritis: epidemiology and health care utilization]. / Aspectos epidemiológicos y carga asistencial de gastroenteritis agudas por Campylobacter y Salmonella.

BACKGROUND AND OBJECTIVE: In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. PATIENTS AND METHODS: Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. RESULTS: The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed between Campylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. CONCLUSION: The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections.

Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine

INTRODUCTION: We describe the pertussis epidemic, based only on confirmed whooping cough cases. We have analyzed data on the diagnosis, epidemiology and vaccine history in order to understand the factors that might explain the trends of the disease. METHODS: A descriptive study of the confirmed pertussis cases reported during 2011 in the Vallès region (population 1,283,000). Laboratory criteria for confirmed pertussis cases include isolation of Bordetella pertussis from a clinical specimen or detection of B. pertussis by PCR in nasopharyngeal swabs. RESULTS: A total of 421 pertussis confirmed cases were reported, which was the highest incidence reported in the last decade (33 cases/100,000 people/year in 2011). The highest incidence rate was among infants less than 1 year old (448/100,000), followed by children 5-9 years old (154/100,000). Pertussis cases aged 2 months-1 year were 90% vaccinated following the current DTaP schedule for their age group in Catalonia, and cases of 5-9 years were 87% fully vaccinated with 5 doses of DTaP vaccine. There were no deaths, although 8% of cases were hospitalized. Pertussis was more severe in infants, 30% required hospitalization despite having received the vaccine doses corresponding to their age. Children of 5-9 years were most often identified as primary cases in households or school clusters. CONCLUSIÓN: Despite high levels of vaccination coverage, pertussis circulation cannot be controlled at all. The results question the efficacy of the present immunization programmes

INTRODUCCIÓN: Se describe la epidemia de tos ferina en el año 2011 solo en casos confirmados. Se analizan datos sobre diagnóstico, epidemiología y antecedentes vacunales que podrían explicar las tendencias de la enfermedad. MÉTODOS: Estudio descriptivo de los casos confirmados de tos ferina notificados durante 2011 en la región del Vallès (población 1.283.000 habitantes). Los criterios de laboratorio para confirmación de un caso incluyen el aislamiento de Bordetella pertussis mediante cultivo en una muestra clínica o detección deB. pertussis por PCR en muestras nasofaríngeas. RESULTADOS: Fueron declarados 421 casos confirmados, siendo la incidencia más alta de los últimos 10 años (33 casos por 100.000 personas/año en 2011). La mayor tasa de incidencia fue en niños < 1 año de edad (448/100.000), seguido de los de 5-9 años (154/100.000). Los casos entre 2 meses y 1 año de edad estaban el 90% vacunados con DTaP según el calendario vacunal vigente en Cataluña para esta edad, entre 5-9 años el 87% estaban completamente vacunados con 5 dosis de DTaP. No hubo defunciones, pero el 8% de los casos fueron hospitalizados. La enfermedad fue más grave en < 1 año, y el 30% fueron hospitalizados a pesar de estar bien vacunados para su edad. Los casos de 5-9 años fueron más frecuentemente identificados como casos primarios en los hogares o grupos escolares. CONCLUSIÓN: A pesar de los altos niveles de cobertura vacunal, la circulación de la tos ferina no se puede controlar del todo. Los resultados ponen en duda la eficacia de los programas de inmunización actuales

Pertussis epidemic despite high levels of vaccination coverage with acellular pertussis vaccine.

INTRODUCTION: We describe the pertussis epidemic, based only on confirmed whooping cough cases. We have analyzed data on the diagnosis, epidemiology and vaccine history in order to understand the factors that might explain the trends of the disease. METHODS: A descriptive study of the confirmed pertussis cases reported during 2011 in the Vallès region (population 1,283,000). Laboratory criteria for confirmed pertussis cases include isolation of Bordetella pertussis from a clinical specimen or detection of B. pertussis by PCR in nasopharyngeal swabs. RESULTS: A total of 421 pertussis confirmed cases were reported, which was the highest incidence reported in the last decade (33 cases/100,000 people/year in 2011). The highest incidence rate was among infants less than 1 year old (448/100,000), followed by children 5-9 years old (154/100,000). Pertussis cases aged 2 months-1 year were 90% vaccinated following the current DTaP schedule for their age group in Catalonia, and cases of 5-9 years were 87% fully vaccinated with 5 doses of DTaP vaccine. There were no deaths, although 8% of cases were hospitalized. Pertussis was more severe in infants, 30% required hospitalization despite having received the vaccine doses corresponding to their age. Children of 5-9 years were most often identified as primary cases in households or school clusters. CONCLUSION: Despite high levels of vaccination coverage, pertussis circulation cannot be controlled at all. The results question the efficacy of the present immunization programmes.