Ten-year population-based molecular epidemiological study of tuberculosis transmission in the metropolitan area of Madrid, Spain.

SETTING: The epidemiology of tuberculosis (TB) in urban populations is changing. Combining conventional epidemiological techniques with DNA fingerprinting of Mycobacterium tuberculosis can improve our understanding of how TB is transmitted. OBJECTIVE: To improve the definition of molecular epidemiology of TB over 10 years in an area of Europe not previously studied. DESIGN: A population-based retrospective study was conducted in the Autonomous Community of Madrid, Spain, from 1992 to 1998; from 1999 to 2001, the study was prospective. The study population consisted of all patients for whom positive culture and full clinical and demographic data were available. All strains were typed by RFLP. Non-clustered patients were compared with clustered patients and studied using univariate analysis and a logistic regression model. RESULTS: Of 448 patients studied, 228 (50.7%) were clustered. Youth was the strongest risk factor associated with clustering. Pleural effusion was also found to be associated with clustering. An epidemiological link was found in only 85 (37.4%) of the 228 patients belonging to a cluster. CONCLUSION: Youth and pleural effusion were identified as risk factors for clustering. These findings may help adjust TB control and contact tracing strategies.

[Evolution of meningococcal disease in the community of Madrid. Effectiveness of antimeningococcal A+C vaccination]. / Evolución de la enfermedad meningocócica en la Comunidad de Madrid. Efectividad de la vacunación antimeningocócica A + C.

BACKGROUND: In 1997 (between 22 September and 14 November) an A + C meningococcal mass vaccination campaign was carried out in Madrid, targeting the age group of from 18 months to 19 years of age, in the face of an increase in the number of cases of meningococcal disease caused by serogroup C occurring in the 1996-97 season. This study forms a part of the impact assessment of that campaign. METHODS: The evolution of the meningococcal disease, by means of the comparison of rates of incidence; and the efficacy of the vaccination campaign was determined after one year (1997-98 season) and after two years (1997-98 and 1998-99 seasons) of monitoring. The vaccine efficacy has been calculated as [1-(Incidence rate in vaccinated/Incidence rate in unvaccinated)]* 100. RESULTS: A significant drop was registered in the incidence of serogroup C meningococcal disease on comparing the 1997-98 and 1998-99 seasons with the epidemic season (1996-97). The vaccine efficacy after two years of monitoring subsequent to the vaccination campaign was 76.9% for the global population between 18 months and 19 years of age and 88.5% in the group of vaccinated individuals between 15 and 19 years of age. CONCLUSIONS: The vaccine efficacy obtained is compatible with that described in the relevant literature. The significant reduction in the incidence of meningococcal disease caused by serogroup C was due to the vaccine efficacy obtained.