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.

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.

[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.

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)

[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.

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

Fundamentos: Para un buen desarrollo de los programas de vacunación es primordial conocer la cobertura de vacunación. En las Islas Baleares la cobertura notificada era muy inferior a la del resto de España. El objetivo de este trabajo es la estimación de la cobertura de las vacunas incluidas en el calendario recomendado hasta los 18 meses de edad (4 dosis de polio oral, tétanos y difteria; 3 de tosferina; 1 de sarampión, rubeola y parotiditis).Métodos: Estudio descriptivo, transversal, de base poblacional. Se calcularon los estimadores puntuales de distribución de frecuencias y los intervalos de confianza al 95 per cent (IC95 per cent) correspondientes, sobre una muestra de la población residente en Baleares de dos años de edad (nacida en 1995), seleccionada por muestreo aleatorio por conglomerados en una sola etapa a partir de las secciones censales. Se consultan los registros de vacunas de Sanidad y de los centros de salud del Insalud, se pide telefónicamente a las familias los datos del documento de vacunación y a los pediatras privados los de la historia clínica. Resultados: La muestra incluía 606 niños. Pudo obtenerse la información completa de 532. Se consiguió la información completa de 377 casos (62 per cent) a partir de los registros del sector público. La cobertura más baja fue la de la vacuna antidiftérica, 518 niños complentamente vacunados, el 96,8 per cent (IC95 per cent = 94,8 - 98,1) y la más alta la de la vacuna antipertussis, 537 niños, el 98,9 per cent (IC95 per cent = 97,5 - 99,5).Conclusiones: En las Islas Baleares existe una buena cobertura de la vacunación, similar a lo que se viene estimando en España en su totalidad. Se cumple el objetivo incluido en el Plan de Erradicación de la Polio. La información recogida desde el sector público es escasa (AU)