Hepatitis A: elevada susceptibilidad en nuestra población joven / Hepatitis A: High susceptibility in our young population

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Brote de botulismo en Castellón / Botulism outbreak in Castellón (Spain)

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Estimación de la incidencia de síndrome gripal durante la pandemia de gripe de 2009 / An estimate of the incidence of influenza-like illness during the influenza pandemic of 2009

Introducción: La pandemia de gripe de 2009 tuvo una gran repercusión social. Se dedicaron muchos recursos sanitarios a la atención médica, la prevención y la vigilancia epidemiológica. La vigilancia epidemiológica se sustenta en la notificación de casos de síndrome gripal y de casos confirmados de gripe. El objetivo fue la estimación de la incidencia real de síndrome gripal durante la pandemia de gripe de 2009. Métodos: Sistema de captura-recaptura durante el mes de mayor incidencia en Castellón. Se utilizaron 2 sistemas de información: a) sistema electrónico de notificación de enfermedades de declaración obligatoria (EDO), y b) datos de laboratorio (LAB). Las estimaciones se han realizado estratificando por grupo de edad y semana. Se calculó el coeficiente de independencia en estos estratos. Resultados: En total se identificaron 7.181 casos EDO y 524 LAB, de los que 211 coincidían en ambos sistemas. La estimación total fue de 17.785 casos en un mes. Ello significa que en el periodo estudiado casi el 4% de las personas del área sufrieron un cuadro gripal (incidencia acumulada), y aproximadamente una de cada 100 personas estuvo diariamente afectada (prevalencia diaria). Acudieron a consulta de atención primaria (EDO) un 40% de los afectados (sensibilidad del sistema EDO). Conclusiones: Para obtener una estimación de la incidencia real en la población durante la pandemia habría que multiplicar la cifra de consultas médicas por un factor de 2,5. Este factor es inferior al estimado en periodos sin alerta pandémica

Introduction: The influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009. Methods: The capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i) electronic reporting of Notifiable Diseases (ND), and (ii) laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata. Results: No dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care. Conclusions: To obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period,the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert

Epidemias de sarampión y efectividad de la vacunación anti-sarampión / Measles epidemics and effectiveness of measles vaccinations

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An estimate of the incidence of influenza-like illness during the influenza pandemic of 2009.

INTRODUCTION: The influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009. METHODS: The capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i)electronic reporting of Notifiable Diseases (ND), and (ii)laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata. RESULTS: No dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care. CONCLUSIONS: To obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period, the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert.

Situación de la tos ferina en la Comunidad Valenciana: ¿asistimos a una reactivación epidémica? / Situation of pertussis in the Community of Valencia: An epidemic revival?

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Effectiveness of seasonal 2008-2009, 2009-2010 and pandemic vaccines, to prevent influenza hospitalizations during the autumn 2009 influenza pandemic wave in Castellón, Spain. A test-negative, hospital-based, case-control study.

We estimate the impact of the two previous influenza seasonal vaccines and the pandemic vaccine on risk of A (H1N1) 2009 laboratory confirmed hospitalizations during the autumn 2009 pandemic wave in Castellón, Spain. We conducted a test-negative, hospital-based, case-control study. Influenza A (H1N1) 2009 infection was detected in 147 (44%) of 334 patients hospitalized for a presumptive influenza related illness. No effect was observed for the 2008-2009 and 2009-2010 seasonal influenza vaccines. However, the pandemic vaccine was associated with an adjusted vaccine effectiveness of 90% (95% CI, 48-100%). Pandemic vaccines were effective in preventing pandemic influenza associated hospitalizations.

[Pseudomonas aeruginosa: antimicrobial resistance in clinical isolates. Castellón 2004-2008]. / Pseudomonas aeruginosa: resistencia antimicrobiana en aislados clínicos. Castellón 2004-2008.

Retrospective study of antimicrobial susceptibility of 1.943 Pseudomonas aeruginosa clinical isolates to amikacin, tobramycin, gentamicin, ceftazidime, cefepime, meropenem, piperacillin-tazobactam and ciprofloxacin during a five year period. The percentage of resistance went from 2.07% to amikacin from 15.89% to ciprofloxacin. These percentages showed differences depending on the extra or intrahospital origin, departments and samples. Isolates from hospital patients were significantly more resistant than the ones from ambulatory patients (p < or = 0.001;tobramycin,13.74% vs 5.05%; gentamicin, 13.74% vs 8.26%; ceftazidime, 12.67% vs 4.24%; cefepime, 11.48% vs 7.07%; meropenem, 8.57% vs 2.06%), except for amikacin (1.98% vs 2.2%, p=0.74), piperacillin/ tazobactam (6.07% vs 4.55%, p=0.14) and ciprofloxacin (17.17% vs 13.97%, p=0.06).Critical care department and respiratory samples showed the highest resistance percentages while surgery department and invasive samples showed the lowest. Multidrug-resistance was found in 4.8% of the isolates. When comparing our data with those from our previous study (1992-2003), we observed a significant reduction in antibiotic resistance to amikacin (7.74% vs 2.07%, p<0.001), tobramycin (13.61% vs 10.26%, p<0.001), gentamicin (30.85% vs 14.73%, p<0,001), ceftazidime (14.63% vs 9,28%, p<0.001), cefepime (12.31% vs 9.71%, p=0.005), and meropenem (7.74% vs 2.07%, p=0.001); and there were no changes in resistance to piperacillin-tazobactam (4.26% vs 5.46%, p=0,06) and ciprofloxacin (16.02% vs 15.89%, p=0.89). In the last years, the susceptibility pattern of P. aeruginosa to antimicrobial agents has changed in our health district, and it is very different from the one described in national studies so it would be very important to monitor susceptibility of clinical isolates periodically.

Pseudomonas aeruginosa: resistencia antimicrobiana en aislados clínicos. Castellón 2004 - 2008 / Pseudomonas aeruginosa: antimicrobial resistance in clinical isolates. Castellón 2004 - 2008

Estudio retrospectivo de la resistencia de 1.943 aisladosclínicos de Pseudomonas aeruginosa a amikacina, tobramicina,gentamicina, ceftazidima, cefepima, meropenem, piperacilina-tazobactam y ciprofloxacino durante un periodo de 5años.La resistencia global osciló desde el 2,07% para amikacinaal 15,89% para ciprofloxacino con diferencias según la procedenciadel paciente, servicios y muestras: los aislamientos depacientes ingresados fueron significativamente más resistentesque los de los ambulatorios, (p≤0,001: tobramicina, 13,74%vs 5,05%; gentamicina, 13,74% vs 8,26%; ceftazidima, 12,67%vs 4,24%; cefepima, 11,48% vs 7,07%; meropenem, 8,57% vs2,06%), salvo para amikacina (1,98% vs 2,2%, p=0,74), piperacilina/tazobactam (6,07% vs 4,55%, p=0,14) y ciprofloxacino(17,17% vs 13,97%, p=0,06). Los servicios de críticos y lasmuestras respiratorias presentaron las tasas más altas de resistenciamientras que los servicios quirúrgicos y las muestras invasivaspresentaron la mejor sensibilidad. Un 4,8% de los aislamientosfueron multirresistentes.Comparado con nuestro anterior estudio (1.992-2.003)observamos un descenso significativo de resistencia a amikacina(7,74% vs 2,07%, p<0,001), tobramicina (13,61% vs10,26%, p<0,001), gentamicina (30,85% vs 14,73%, p<0,001)ceftazidima (14,63% vs 9,28%, p<0,001), cefepima (12,31% vs9,71%, p=0,005) y meropenem (8,84% vs 5,96%, p=0,001) y semantienen piperacilina/tazobactam (4,26% vs 5,46%, p=0,06)y ciprofloxacino (16,02% vs 15,89%, p=0,89).En nuestra zona se ha producido en los últimos años uncambio en los patrones de susceptibilidad de P. aeruginosa,alejado del descrito a nivel nacional, lo que incide en la importanciadel seguimiento local periódico de la susceptibilidad delos aislados clínicos(AU)

Retrospective study of antimicrobial susceptibility of1.943 Pseudomonas aeruginosa clinical isolates to amikacin,tobramycin, gentamicin, ceftazidime, cefepime,meropenem, piperacillin-tazobactam and ciprofloxacinduring a five year period.The percentage of resistance went from 2.07% toamikacin from 15.89% to ciprofloxacin. These percentagesshowed differences depending on the extra or intrahospitalaryorigin, departments and samples. Isolatesfrom hospital patients were significantly more resistantthan the ones from ambulatory patients (p≤0.001:tobramycin,13.74% vs 5.05%; gentamicin, 13.74% vs8.26%; ceftazidime, 12.67% vs 4.24%; cefepime, 11.48%vs 7.07%; meropenem, 8.57% vs 2.06%),except for amikacin(1.98% vs 2.2%, p=0.74), piperacillin/tazobactam(6.07% vs 4.55%, p=0.14) and ciprofloxacin (17.17% vs13.97%, p=0.06). Critical care department and respiratorysamples showed the highest resistance percentageswhile surgery department and invasive samples showedthe lowest. Multidrug-resistance was found in 4.8% ofthe isolates.When comparing our data with those from our previousstudy (1992-2003), we observed a significant reductionin antibiotic resistance to amikacin (7.74% vs2.07%, p<0.001), tobramycin (13.61% vs 10.26%,p<0.001), gentamicin (30,85% vs 14.73%, p<0,001), ceftazidime(14.63% vs 9,28%, p<0.001), cefepime (12,31%vs 9.71%, p=0.005), and meropenem (7.74% vs 2.07%,p=0.001); and there were no changes in resistance to piperacillin-tazobactam (4.26% vs 5.46%, p=0,06) and ciprofloxacin (16.02% vs 15.89%, p=0.89).In the last years, the susceptibility pattern of P. aeruginosato antimicrobial agents has changed in our healthdistrict, and it is very different from the one describedin national studies so it would be very important tomonitore susceptibility of clinical isolates periodically(AU)

[Trichosporon asahii fatal infection in a preterm newborn]. / Infección fatal por Trichosporon asahii en una recién nacida de pretérmino.

We present a case of Trichosporon asahii fatal infection recognized post mortem in a premature newborn baby of 685 g. Trichosporon asahii isolated from endovascular catheters and endotraqueal tube, is an opportunistic yeast described like an emergent pathogen in serious systemic infections and nosocomial infections in the neonatal intensive care units. The colonization and disease by this uncommon microorganism, usually is unspecific and has similar clinical presentation to other fungal infections with a bad prognosis.

Infección fatal por Trichosporon asahii en una recién nacida de pretérmino / Trichosporon asahii fatal infection in a preterm newborn

Se presenta un caso fatal de infección por Trichos-poron asahii diagnosticado post mortem en una neonato de pretérmino que pesó 685 grs al nacer. De los cultivos de catéteres y del tubo endotraqueal se aisló T. asahii, levadura oportunista descrita como un patógeno emergente en infecciones sistémicas graves e infecciones nosocomiales en las unidades de cuidados intensivos neonatales. La colonización y enfermedad por este microorganismo poco común suele ser inespecífica y con mal pronóstico, de presentación clínica similar a otras infecciones fúngicas.

We present a case of Trichosporon asahii fatal infection recognized post mortem in a premature newborn baby of 685 g. Trichosporon asahii isolated from endovascular catheters and endotraqueal tube, is an opportunistic yeast described like an emergent pathogen in serious systemic infections and nosocomial infections in the neonatal intensive care units. The colonization and disease by this uncommon microorganism, usually is unspecific and has similar clinical presentation to other fungal infections with a bad prognosis.

Varicella vaccine effectiveness during an outbreak in a partially vaccinated population in Spain.

BACKGROUND: An outbreak of varicella occurred between December 2004 and April 2005 in the primary school and day-care center of a town of 5430 inhabitants in Spain. Although the varicella vaccine is not included in the infant vaccination program, some children had been vaccinated before the outbreak. STUDY AIM: The aim of this study was to estimate varicella vaccine effectiveness during an outbreak that took place in a partially vaccinated population of children. METHODS: A cohort study was carried out. Cases were identified through notification by doctors and active search. Information was gathered on the current disease, history of varicella and previous vaccinations together with age, course, school year and other sociodemographic factors. The relative risk (RR) of varicella and the contribution of the previously mentioned factors to the probability of contracting the disease was estimated for vaccinated and unvaccinated children. RESULTS: Participation reached 96.5% (387 of 401 children) in the school and 91.2% (31 of 34 children) in the day-care center. Of 269 children with no history of varicella and with a documented vaccination record, 96 (35.7%) had been previously vaccinated. During the outbreak, 148 cases of varicella were observed. The overall attack rate was 54.4%, 22.9% in vaccinated and 72.8% in unvaccinated children. RR of varicella in vaccinated children was 0.31 (95% confidence interval [CI] = 0.21-0.46). The overall adjusted vaccine effectiveness against varicella was 69.5% (95% CI = 50.5-81.5%) and 96.9% (95% CI = 77.5-99.6%) against mild and severe forms. Only time since vaccination was associated with vaccine failure. CONCLUSIONS: In the varicella outbreak studied, we conclude that vaccine was effective in the prevention of the disease, particularly in its moderate and severe forms, but because the proportion of vaccinated children was low, an outbreak still occurred.

[Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995-2003]. / Impacto de la inmigración en las resistencias de Mycobacterium tuberculosis en la provincia de Castellón: 1995-2003.

BACKGROUND AND OBJECTIVE: The aim of this study was to know the frequency of resistant Mycobacterium tuberculosis in the province of Castellon (Spain) and to determine whether immigration is associated with resistance. MATERIAL AND METHOD: All culture-positive cases diagnosed in Castellon from January 1995 to December 2003 were included in this retrospective study. Susceptibility tests were performed using the Canetti's proportion method and the MB/BacT system. Risk factors associated with tuberculosis were investigated in every case. RESULTS: Six hundred and forty-four cases of tuberculosis were studied: 560 were Spaniards and 84 foreigners. The overall frequency of resistant strains was 5%. The total rate of resistance in Spaniards was 3.7% and in foreigners 13.1%. In Spanish new cases, drug resistance was 3.2% and in foreigners new cases it was 13.9%. In previously treated cases, drug resistance was 6.7% in Spaniards and 0% in immigrants. No acquired drug resistance was detected in immigrants. Of those strains with resistance, 71.9% had resistance to only one drug, 18.7% to two drugs and 9.4% to more than two drugs. Multidrug-resistance was found in 9.4% of the resistant cases, and in 0.5% of all the studied population. The presence of resistant Mycobacterium tuberculosis was associated with the fact of having a foreign nationality (OR = 3.87; p < 0.001). CONCLUSIONS: Tuberculosis has been diminishing in Spanish patients in Castellon. Nevertheless, there is an important increase in the number of cases in foreigners, which is associated with a major percentage of resistances. Epidemiological vigilance efforts should especially concentrate on this group in order to support the progressive declivity of the disease.

Impacto de la inmigración en las resistencias de Mycobacterium tuberculosis en la provincia de Castellón: 1995-2003 / Impact of immigration on drug resistance to Mycobacterium tuberculosis in Castellon (Spain): 1995-2003

Fundamento y objetivo: El objetivo del presente estudio es conocer la frecuencia de las resistencias de Mycobacterium tuberculosis en la provincia de Castellón y la influencia de la inmigración en su aparición. Material y método: Se ha realizado un estudio retrospectivo de todos los casos de tuberculosis con cultivo positivo diagnosticados en la provincia de Castellón entre enero de 1995 y diciembre de 2003 (9 años). El estudio de sensibilidad se ha llevado a cabo por el método de las proporciones de Canetti y por el sistema MB/BacT. Se ha investigado los factores de riesgo relacionados con la tuberculosis en cada uno de los casos. Resultados: Se ha estudiado 644 casos, 560 españoles y 84 extranjeros. Se ha detectado una tasa total de resistencia del 5%. En españoles, las resistencias totales han sido del 3,7% y en extranjeros, del 13,1%. En casos nuevos se ha encontrado un 3,2% de resistencias en españoles y un 13,9% en extranjeros, y en casos con tratamiento previo, un 6,7% en españoles y ninguno en inmigrantes. El 71,9% de las cepas con resistencia la tienen a 1 solo fármaco; el 18,7%, a 2, y el 9,4%, a más de 2. Los casos multirresistentes han supuesto un 9,4% de las resistencias y, con relación al total de la población estudiada, el 0,5%. De todas las variables analizadas, la única relacionada con la aparición de resistencias ha sido la nacionalidad extranjera (odds ratio [OR] = 3,87; p < 0,001). Conclusiones: La tuberculosis ha ido disminuyendo entre los pacientes españoles en la provincia de Castellón. Sin embargo, se aprecia un importante aumento del número de casos entre los extranjeros, que se ha relacionado con un mayor porcentaje de resistencias. Por todo ello, creemos que la vigilancia epidemiológica debe incidir especialmente en ese colectivo, a fin de mantener el progresivo declive de la enfermedad en nuestro medio

Background and objective: The aim of this study was to know the frequency of resistant Mycobacterium tuberculosis in the province of Castellon (Spain) and to determine whether immigration is associated with resistance. Material and method: All culture-positive cases diagnosed in Castellon from January 1995 to December 2003 were included in this retrospective study. Susceptibility tests were performed using the Canetti's proportion method and the MB/BacT system. Risk factors associated with tuberculosis were investigated in every case. Results: Six hundred and forty-four cases of tuberculosis were studied: 560 were Spaniards and 84 foreigners. The overall frequency of resistant strains was 5%. The total rate of resistance in Spaniards was 3.7% and in foreigners 13.1%. In Spanish new cases, drug resistance was 3.2% and in foreigners new cases it was 13.9%. In previously treated cases, drug resistance was 6.7% in Spaniards and 0% in immigrants. No acquired drug resistance was detected in immigrants. Of those strains with resistance, 71.9% had resistance to only one drug, 18.7% to two drugs and 9.4% to more than two drugs. Multidrug-resistance was found in 9.4% of the resistant cases, and in 0.5% of all the studied population. The presence of resistant Mycobacterium tuberculosis was associated with the fact of having a foreign nationality (OR = 3.87; p < 0.001). Conclusions: Tuberculosis has been diminishing in Spanish patients in Castellon. Nevertheless, there is an important increase in the number of cases in foreigners, which is associated with a major percentage of resistances. Epidemiological vigilance efforts should especially concentrate on this group in order to support the progressive declivity of the disease