Progresión temporal de la distribución de los serotipos de Streptococcus pneumoniae productores de enfermedad neumocócica invasiva en Galicia (España) y su relación con la resistencia a antibióticos (periodo 2011-2021) / Temporal progression of the distribution of Streptococcus pneumoniae serotypes causing invasive pneumococcal disease in Galicia (Spain) and its relationship with resistance to antibiotics (period 2011-2021)

Introducción: Streptococcus pneumoniae causa enfermedades graves en la población susceptible. La vacuna neumocócica conjugada (PCV) 13-valente (PCV13) se incluyó en el calendario infantil en 2011. Este estudio analiza la evolución de los serotipos de neumococo y de sus resistencias tras la PCV13. Métodos: Se incluyeron los neumococos serotipados en Galicia en 2011-2021. Se estudió la sensibilidad antibiótica siguiendo criterios EUCAST. Se analizaron los datos en 3 subperíodos: inicial (2011-2013), medio (2014-2017) y final (2018-2021). Se calcularon las prevalencias de los serotipos y el porcentaje de resistencia a los antibióticos más representativos. Resultados: Se incluyeron 2.869 aislados. Inicialmente el 42,7% presentaba tipos capsulares incluidos en la PCV13, frente al 15,4% al final. Los incluidos en la PCV20 y no en la PCV13 y PCV15 fueron el 12,5% inicialmente y el 41,3% al final. El 26,4% de los serotipos a lo largo del estudio no estaban incluidos en ninguna vacuna. La prevalencia del serotipo 8 se multiplicó casi por 8 y la del 12F se triplicó. El serotipo 19A fue el más resistente inicialmente. La resistencia de los serotipos 11A y 15A aumentó a lo largo del estudio. Conclusiones: La introducción de la PCV13 en la población infantil determinó un cambio en los serotipos de neumococo hacia los incluidos en la PCV20 y los no incluidos en ninguna vacuna. El serotipo 19A inicialmente fue el más resistente, y el 15A, no incluido en ninguna vacuna, merece un especial seguimiento. El serotipo 8, que fue el que más se incrementó, no mostró resistencia destacable.(AU)

Introduction: Streptococcus pneumoniae causes serious diseases in the susceptible population. The 13-valent pneumococci conjugate vaccine (PCV13) was included in the children's calendar in 2011. The objective of the study was to analyze the evolution of pneumococcal serotypes and their resistance after PCV13. Methods: This study included the pneumococci serotyped in Galicia in 2011-2021. Antibiotic susceptibility was analyzed following EUCAST criteria. The data was analyzed in 3 sub-periods: initial (2011-2013), middle (2014-2017) and final (2018-2021). The prevalence of serotypes and their percentage of resistance to the most representative antibiotics were calculated. Results: A total of 2.869 isolates were included. Initially, 42.7% isolates presented capsular types included in PCV13, compared to 15.4% at the end. Those included in PCV20 and not in PCV13 and PCV15 were 12.5% at baseline and 41.3% at the end; 26.4% of the isolates throughout the study had serotypes not included in any vaccine. The prevalence of serotype 8 multiplied almost by 8 and that of 12F tripled. The 19A serotype was initially the most resistant, while the resistance of serotypes 11A and 15A increased throughout the study. Conclusions: The introduction of PCV13 in the pediatric population determined a change in pneumococcal serotypes towards those included in PCV20 and those not included in any vaccine. Serotype 19A was initially the most resistant and the 15A, not included in any vaccine, deserves special follow-up. Serotype 8, which increased the most, did not show remarkable resistance.(AU)

Temporal progression of the distribution of Streptococcus pneumoniae serotypes causing invasive pneumococcal disease in Galicia (Spain) and its relationship with resistance to antibiotics (period 2011-2021).

INTRODUCTION: Streptococcus pneumoniae causes serious diseases in the susceptible population. The 13-valent pneumococci conjugate vaccine (PCV13) was included in the children's calendar in 2011. The objective of the study was to analyze the evolution of pneumococcal serotypes and their resistance after PCV13. METHODS: This study included the pneumococci serotyped in Galicia in 2011-2021. Antibiotic susceptibility was analyzed following EUCAST criteria. The data was analyzed in 3 sub-periods: initial (2011-2013), middle (2014-2017) and final (2018-2021). The prevalence of serotypes and their percentage of resistance to the most representative antibiotics were calculated. RESULTS: A total of 2.869 isolates were included. Initially, 42.7% isolates presented capsular types included in PCV13, compared to 15.4% at the end. Those included in PCV20 and not in PCV13 and PCV15 were 12.5% at baseline and 41.3% at the end; 26.4% of the isolates throughout the study had serotypes not included in any vaccine. The prevalence of serotype 8 multiplied almost by 8 and that of 12F tripled. The 19A serotype was initially the most resistant, while the resistance of serotypes 11A and 15A increased throughout the study. CONCLUSIONS: The introduction of PCV13 in the pediatric population determined a change in pneumococcal serotypes towards those included in PCV20 and those not included in any vaccine. Serotype 19A was initially the most resistant and the 15A, not included in any vaccine, deserves special follow-up. Serotype 8, which increased the most, did not show remarkable resistance.

[Impact of COVID-19 pandemic in terms of incidence and lethality in nursing homes in Galicia (Spain)]. / Impacto de la pandemia de COVID-19 en términos de incidencia y letalidad en los centros residenciales de mayores de Galicia.

OBJECTIVES: To know the impact of COVID-19 in incidence and lethality in nursing homes in Galicia. METHODS: This is a descriptive study of nursing homes residents and workers with confirmed COVID-19. The analysis spanned from March 1, 2020 to March 27, 2022, stratified into 6 periods (one per wave). The impact on incidence (attack rate, number of outbreaks, reinfections, sex, age, and diagnostic technique) and lethality (by sex, age, place of death, and number of centers with deaths) was analyzed. RESULTS: There were 15,819 people affected, 51.9% of the jobs and 47.0% of the workers. The attack rate in residents was: 5.8% in the first wave, 10.4% in the second, 6.3% in the third, 0.1% in the fourth, 2.1% in the fifth and 27.3% in the sixth. In the sixth wave, there were 11.3% reinfections and the number of outbreaks in was 3 times higher than in the second. The case fatality in residents was higher during the first wave (21.8%) and lower during the sixth (2.4%). He only had one worker in relation to COVID-19. CONCLUSIONS: Surveillance of COVID-19 in nursing homes was essential to understand the dynamics of the disease. The sixth wave was the one with the highest incidence and the lowest lethality. Lethality was higher in the first wave. The fourth and fifth waves had a lower incidence due to the effects of vaccination.

Impacto de la pandemia de COVID-19 en términos de incidencia y letalidad en los centros residenciales de mayores de Galicia / Impact of COVID-19 pandemic in terms of incidence and lethality in nursing homes in Galicia (Spain)

Objetivos: Conocer el impacto de la COVID-19 en incidencia y letalidad en los centros residenciales de mayores (CRM) de Galicia. Métodos: Se trata de un estudio descriptivo en residentes y trabajadores de los CRM con COVID-19 confirmada. El análisis abarcó del 1 de marzo de 2020 al 27 de marzo de 2022 y se estratificó en 6 períodos (uno por ola). Se analizó el impacto en incidencia (tasa de ataque, número de brotes, reinfecciones, sexo, edad y técnica diagnóstica) y letalidad (por sexo, edad, lugar de fallecimiento y número de centros con fallecidos). Resultados: Hubo 15.819 personas afectadas, el 51,9% de las plazas y el 47% de los trabajadores. La tasa de ataque en residentes fue: 5,8% en la primera ola, 10,4% en la segunda, 6,3% en la tercera, 0,1% en la cuarta, 2,1% en la quinta y 27,3% en la sexta ola. En la sexta ola hubo un 11,3% de reinfecciones y el número de brotes fue 3 veces mayor que en la segunda. La letalidad en residentes fue mayor durante la primera ola (21,8%) y menor durante la sexta (2,4%). Solo falleció un trabajador en relación con la COVID-19. Conclusiones: La vigilancia de la COVID-19 en CRM fue fundamental para conocer la dinámica de la enfermedad. La sexta ola fue la de mayor incidencia y la de menor letalidad. La letalidad fue superior en la primera ola. La cuarta y la quinta ola tuvieron menor incidencia debido a los efectos de la vacunación. (AU)

Objectives: To know the impact of COVID-19 in incidence and lethality in nursing homes in Galicia. Methods: This is a descriptive study of nursing homes residents and workers with confirmed COVID-19. The analysis spanned from March 1, 2020 to March 27, 2022, stratified into 6 periods (one per wave). The impact on incidence (attack rate, number of outbreaks, reinfections, sex, age, and diagnostic technique) and lethality (by sex, age, place of death, and number of centers with deaths) was analyzed. Results: There were 15,819 people affected, 51.9% of the jobs and 47.0% of the workers. The attack rate in residents was: 5.8% in the first wave, 10.4% in the second, 6.3% in the third, 0.1% in the fourth, 2.1% in the fifth and 27.3% in the sixth. In the sixth wave, there were 11.3% reinfections and the number of outbreaks in was 3 times higher than in the second. The case fatality in residents was higher during the first wave (21.8%) and lower during the sixth (2.4%). He only had one worker in relation to COVID-19. Conclusions: Surveillance of COVID-19 in nursing homes was essential to understand the dynamics of the disease. The sixth wave was the one with the highest incidence and the lowest lethality. Lethality was higher in the first wave. The fourth and fifth waves had a lower incidence due to the effects of vaccination. (AU)

COVID-19 vaccine effectiveness against hospitalization due to SARS-CoV-2: A test-negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain.

BACKGROUND: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals. METHODS: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS-CoV-2 variant. RESULTS: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. CONCLUSIONS: The SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID-19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID-19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS-CoV-2 variants (Alpha vs. Delta).

¿Necesidad de cambio en la definición de caso del sarampión? / Is it necessary to change the measles case definition?

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De la vigilancia a la acción: modificando conductas terapéuticas en la infección gonocócica / From surveillance to action: Modifying therapeutic behaviours in gonococcal infections

OBJETIVOS: Evaluar la mejora en la prescripción del tratamiento ante una sospecha de infección gonocócica tras desarrollarse una intervención sanitaria específica; además, conocer la fracción de casos diagnosticados por cultivo y las resistencias antimicrobianas de las cepas de Neisseria gonorrhoeae que circulan en nuestra comunidad. Emplazamiento: Galicia, España. DISEÑO: Estudio antes-después de la adherencia al tratamiento recomendado para la infección gonocócica (ceftriaxona más azitromicina), tras una intervención de Salud Pública. PARTICIPANTES: Todos los médicos de atención primaria que identifican y tratan un caso de infección gonocócica. PERIODO DE ESTUDIO: Preintervención (2012-13) y postintervención (2014-17). INTERVENCIONES: Se facilitó el acceso en atención primaria al tratamiento recomendado (ceftriaxona y azitromicina) y se difundió toda la información a los médicos de atención primaria y microbiólogos a través de la publicación Venres Epidemiolóxico. Mediciones principales: Las variables a estudio fueron: año, tratamiento prescrito, realización de cultivo, sensibilidad a antibióticos. Se calcularon los porcentajes para cada una de ellas. RESULTADOS: El tratamiento recomendado se empleó en un 3% en 2012-2013, aumentando, después de las intervenciones, a un 58% de media. La frecuencia de cultivo se mantuvo relativamente constante después de las intervenciones. La sensibilidad a otros antibióticos mejoró al disminuir su uso. CONCLUSIONES: Las intervenciones realizadas supusieron una mejora en la adherencia al tratamiento recomendado para la infección gonocócica en Galicia

OBJECTIVES: To evaluate improvements in the prescriptions for gonococcal infection after developing a specific public health intervention. Furthermore, to ascertain the proportion of cases diagnosed by culture and current antimicrobial resistance. LOCATION: Galicia, Spain. DESIGN: Before-after study of adherence to the recommended treatment for gonococcal infection (ceftriaxone + azithromycin) after a Public Health intervention. PARTICIPANTS: All Primary Care physicians who had identified and treated a case of gonococcal infection. Study period: Preintervention (2012-13) and postintervention (2014-17). INTERVENTIONS: Access to the recommended treatment (ceftriaxone and azithromycin) was provided in Primary Care and all the information was disseminated to Primary Care physicians and microbiologists through the publication Venres Epidemiolóxico. MAIN MEASUREMENTS: The study variables were year, prescribed treatment, performing of culture, antibiotic susceptibility testing. The percentages for each of them were calculated. RESULTS: The recommended treatment was used in 3% in 2012-2013, and after the interventions it increased to a mean of 58%. The frequency of culture remained relatively constant after the interventions. Sensitivity to other antibiotics improved as their use decreased. CONCLUSIONS: The interventions carried out implied an improvement in the adherence to the recommended treatment for gonococcal infection in Galicia

[From surveillance to action: Modifying therapeutic behaviours in gonococcal infections]. / De la vigilancia a la acción: modificando conductas terapéuticas en la infección gonocócica.

OBJECTIVES: To evaluate improvements in the prescriptions for gonococcal infection after developing a specific public health intervention. Furthermore, to ascertain the proportion of cases diagnosed by culture and current antimicrobial resistance. LOCATION: Galicia, Spain. DESIGN: Before-after study of adherence to the recommended treatment for gonococcal infection (ceftriaxone + azithromycin) after a Public Health intervention. PARTICIPANTS: All Primary Care physicians who had identified and treated a case of gonococcal infection. STUDY PERIOD: Preintervention (2012-13) and postintervention (2014-17). INTERVENTIONS: Access to the recommended treatment (ceftriaxone and azithromycin) was provided in Primary Care and all the information was disseminated to Primary Care physicians and microbiologists through the publication Venres Epidemiolóxico. MAIN MEASUREMENTS: The study variables were year, prescribed treatment, performing of culture, antibiotic susceptibility testing. The percentages for each of them were calculated. RESULTS: The recommended treatment was used in 3% in 2012-2013, and after the interventions it increased to a mean of 58%. The frequency of culture remained relatively constant after the interventions. Sensitivity to other antibiotics improved as their use decreased. CONCLUSIONS: The interventions carried out implied an improvement in the adherence to the recommended treatment for gonococcal infection in Galicia.

Streptococcus pneumoniae: distribución de serotipos, sensibilidad antibiótica, factores de riesgo y mortalidad en Galicia en un periodo de 2 años / Streptococcus pneumoniae: Serotype distribution, antimicrobial susceptibility, risk factors and mortality in Galicia over a two year-period

INTRODUCCIÓN: Para conocer la epidemiología de la infección neumocócica en Galicia (España) tras la incorporación de la vacuna conjugada antineumocócica, se determinaron durante los años 2011 y 2012 la distribución de serotipos, sensibilidad antibiótica, factores de riesgo y mortalidad asociada de los casos de enfermedad neumocócica invasiva (ENI). MÉTODOS: Se estudiaron todas las cepas causantes de ENI en Galicia. El serotipado se realizó por aglutinación y reacción de Quellung. Se determinó la sensibilidad a penicilina, cefotaxima, eritromicina, vancomicina y levofloxacino. Se consideraron factores de riesgo la patología respiratoria crónica, la patología cardíaca, la patología hepática, la patología renal, la diabetes mellitus y la inmunodeficiencia no VIH y VIH. RESULTADOS: Se recogieron 555 cepas. Se encontraron 43 serotipos diferentes, los más frecuentes: serotipo 3 (17,5%), serotipo 7F (12,6%), serotipo 19A (9,4%), serotipo 14 (4,1%), serotipo 6C (4,1%), serotipo 11A (4%) y serotipo 22F (3,8%). El 57,1% de los serotipos aislados estaban incluidos en VNC-13V. Se encontraron 2 cepas no sensibles a penicilina y otras 2 a cefotaxima. El 24,7% de las cepas fueron no sensibles a eritromicina (26,9% en 2011 y 22,5% en 2012). La tasa de letalidad fue del 16,5%, llegando al 23,3% en mayores de 75 años. Las patologías con riesgo de morir que mostraron significación estadística fueron: hepática, renal e inmunodeficiencia no VIH. CONCLUSIONES: El serotipo 3 fue el mayoritario en Galicia. Se encontraron muy pocas cepas no susceptibles a penicilina y un descenso de resistencia a eritromicina de 2011 a 2012. Se observó un incremento de letalidad en relación con la edad del paciente. Padecer patología hepática, renal o inmunodeficiencia no VIH aumentó el riesgo de muerte

INTRODUCTION: To examine the epidemiology of pneumococcal infection in Galicia (Spain) after the incorporation of the pneumococcal conjugate vaccine, and to determine serotype distribution, antibiotic susceptibility, risk factors and associated mortality in cases of invasive pneumococcal disease (IPD) during 2011 and 2012. METHODS: All strains causing IPD in Galicia were studied. Serotyping was performed by agglutination and Quellung reaction. Antibiotic sensitivity to penicillin, cefotaxime, erythromycin, vancomycin, and levofloxacin was determined. The risk factors considered were chronic respiratory disease, heart disease, liver disease, kidney disease, diabetes mellitus, and HIV and non-HIV immunodeficiency. RESULTS: A total of 555 strains were collected, with 43 different serotypes being found. The most frequently isolated ones were: serotype 3 (17.5%), serotype 7F (12.6%), serotype 19A (9.4%), serotype 14 (4.1%), serotype 6C (4.1%), serotype 11A (4%) and serotype 22F (3.8%). 57.1% of isolates were serotypes included in VNC-13V. Two non-penicillin-sensitive strains and two others were not sensitive to cefotaxime, and 24.7% of the strains were not susceptible to erythromycin (26.9% in 2011 and 22.5% in 2012). The case fatality rate was 16.5%, reaching 23.3% in patients over 75 years. Diseases with a statistically significant risk of mortality were: liver, kidney and immunodeficiency without HIV. CONCLUSIONS: Serotype 3 was the most frequent in Galicia. Very few strains were not susceptible to penicillin. Erythromycin resistance decreased from 2011 to 2012. It is highlighted that mortality increases with age. Liver disease, renal disease and non-HIV immunodeficiency increases the mortality risk

[Streptococcus pneumoniae: serotype distribution, antimicrobial susceptibility, risk factors and mortality in Galicia over a two year-period]. / Streptococcus pneumoniae: distribución de serotipos, sensibilidad antibiótica, factores de riesgo y mortalidad en Galicia en un periodo de 2 años.

INTRODUCTION: To examine the epidemiology of pneumococcal infection in Galicia (Spain) after the incorporation of the pneumococcal conjugate vaccine, and to determine serotype distribution, antibiotic susceptibility, risk factors and associated mortality in cases of invasive pneumococcal disease (IPD) during 2011 and 2012. METHODS: All strains causing IPD in Galicia were studied. Serotyping was performed by agglutination and Quellung reaction. Antibiotic sensitivity to penicillin, cefotaxime, erythromycin, vancomycin, and levofloxacin was determined. The risk factors considered were chronic respiratory disease, heart disease, liver disease, kidney disease, diabetes mellitus, and HIV and non-HIV immunodeficiency. RESULTS: A total of 555 strains were collected, with 43 different serotypes being found. The most frequently isolated ones were: serotype3 (17.5%), serotype7F (12.6%), serotype19A (9.4%), serotype14 (4.1%), serotype6C (4.1%), serotype11A (4%) and serotype22F (3.8%). 57.1% of isolates were serotypes included in VNC-13V. Two non-penicillin-sensitive strains and two others were not sensitive to cefotaxime, and 24.7% of the strains were not susceptible to erythromycin (26.9% in 2011 and 22.5% in 2012). The case fatality rate was 16.5%, reaching 23.3% in patients over 75years. Diseases with a statistically significant risk of mortality were: liver, kidney and immunodeficiency without HIV. CONCLUSIONS: Serotype3 was the most frequent in Galicia. Very few strains were not susceptible to penicillin. Erythromycin resistance decreased from 2011 to 2012. It is highlighted that mortality increases with age. Liver disease, renal disease and non-HIV immunodeficiency increases the mortality risk.