[Tuberculosis trend in Madrid region in native and foreign population (2009-2018).] / Tendencia de la tuberculosis en la Comunidad de Madrid en población autóctona y extranjera (2009-2018).

OBJECTIVE: Tuberculosis is a major public health problem and most cases are concentrated in vulnerable populations. The objective was to describe the incidence rates trend in native and foreign population (2009-2018) in Madrid Region. METHODS: Retrospective analysis of cases from the Tuberculosis Regional Registry of cases of Madrid Region 2009-2018. Annual incidence rates were calculated by country of birth (Spain, other), sex and age group (<15, 15-34, 35-44, 45-64, >64), using the annual January 1st continuous register population. The infection rate trend and the annual percentage change (APC) were calculated, along with the best jointpoint adjustment using Jointpoint regression. RESULTS: 7,696 cases were analyzed, 48.2% were foreign-born individuals. Average age in native population was 50 years old (SD: 23.96) and 35 (DS: 36.64) in foreign-born individuals (p<0.001). The overall incidence rate decreased from 17.30 in 2009 to 9.00 per 100,000 in 2018 and was higher in men. Pulmonary tuberculosis reduced from 11.90 to 6.55. Among native population, the incidence of TB fell from 10.29 to 5.24 with an APC of -7.3% (95%IC: -8.9; -5.7) (p<0.05), no jointpoint was identified. Among foreign-born individuals the incidence of tuberculosis declined from 46.54 to 25.49, a joint point was identified in 2013, observing an incidence decrease for the period 2009-2013 and APC of -13.8% (IC95%: -17.5; -10.0). CONCLUSIONS: The global incidence rate in this period has decreased by approximately 7% per year. However, this reduction occurred mainly in native population. In foreign-born individuals the incidence decreased by approximately 14% during the 2009-2013 period, after this period there have been no significant incidence changes.

OBJETIVO: La tuberculosis (TB) continúa siendo un problema importante de salud pública, debido a que la mayoría de los casos se concentran en población vulnerable. El objetivo de este trabajo fue describir la tendencia de las tasas de incidencia en población autóctona y extranjera (2009-2018) en la Comunidad de Madrid (CM). METODOS: Se realizó un análisis retrospectivo de casos del Registro Regional de casos de Tuberculosis de la CM en el período 2009-2018. Se calcularon tasas de incidencia anual por cada 100.000 habitantes, por país de nacimiento (España, fuera de España), sexo y grupo de edad (<15, 15-34, 35-44, 45-64, >64), utilizando las poblaciones de padrón continuo a 1 de enero de cada año. Se calculó la tendencia de las tasas de incidencia y el porcentaje anual de cambio (APC), así como el mejor ajuste del punto de inflexión utilizando la regresión de Jointpoint. RESULTADOS: Se analizaron 7.696 casos, siendo el 48,2% en personas nacidas fuera de España. La edad media en población autóctona fue de 50 años (DS: 23,96) y 35 (DS: 36,64) en inmigrante (p<0,001). La tasa de incidencia global pasó de 17,30 por cada 100.000 habitantes en 2009 a 9 en 2018, siendo superior en hombres. La incidencia de tuberculosis pulmonar pasó de 11,90 a 6,55. En población autóctona, la incidencia de TB pasó de 10,29 a 5,24, con un APC de -7,3% (IC95%: -8,9; -5,7; p<0,05), y no se identificó ningún punto de inflexión. En población extranjera la incidencia de tuberculosis pasó de 46,54 a 25,49, identificándose un punto de inflexión en 2013, con una disminución más acusada de la incidencia para el periodo 2009-2013 debido a un APC de -13,8% (IC95%: -17,5; -10,0). CONCLUSIONES: La tasa de incidencia global en este periodo disminuye cerca de un 7% anual; sin embargo, esta disminución de la incidencia se produce fundamentalmente en población autóctona. En población extranjera la incidencia desciende cerca de un 14% durante el periodo 2009-2013. Tras este periodo no hay cambios significativos en la incidencia.

Tendencia de la tuberculosis en la Comunidad de Madrid en población autóctona y extranjera (2009-2018) / Tuberculosis trend in Madrid region in native and foreign population (2009-2018)

OBJETIVO: La tuberculosis (TB) continúa siendo un problema importante de salud pública, debido a que la mayoría de los casos se concentran en población vulnerable. El objetivo de este trabajo fue describir la tendencia de las tasas de incidencia en población autóctona y extranjera (2009-2018) en la Comunidad de Madrid (CM). MÉTODOS: Se realizó un análisis retrospectivo de casos del Registro Regional de casos de Tuberculosis de la CM en el período 2009-2018. Se calcularon tasas de incidencia anual por cada 100.000 habitantes, por país de nacimiento (España, fuera de España), sexo y grupo de edad (<15, 15-34, 35-44, 45-64, >64), utilizando las poblaciones de padrón continuo a 1 de enero de cada año. Se calculó la tendencia de las tasas de incidencia y el porcentaje anual de cambio (APC), así como el mejor ajuste del punto de inflexión utilizando la regresión de Jointpoint. RESULTADOS: Se analizaron 7.696 casos, siendo el 48,2% en personas nacidas fuera de España. La edad media en población autóctona fue de 50 años (DS: 23,96) y 35 (DS: 36,64) en inmigrante (p < 0,001). La tasa de incidencia global pasó de 17,30 por cada 100.000 habitantes en 2009 a 9 en 2018, siendo superior en hombres. La incidencia de tuberculosis pulmonar pasó de 11,90 a 6,55. En población autóctona, la incidencia de TB pasó de 10,29 a 5,24, con un APC de -7,3% (IC95%: -8,9; -5,7; p < 0,05), y no se identificó ningún punto de inflexión. En población extranjera la incidencia de tuberculosis pasó de 46,54 a 25,49, identificándose un punto de inflexión en 2013, con una disminución más acusada de la incidencia para el periodo 2009-2013 debido a un APC de -13,8% (IC95%: -17,5; -10,0). CONCLUSIONES: La tasa de incidencia global en este periodo disminuye cerca de un 7% anual; sin embargo, esta disminución de la incidencia se produce fundamentalmente en población autóctona. En población extranjera la incidencia desciende cerca de un 14% durante el periodo 2009-2013. Tras este periodo no hay cambios significativos en la incidencia

OBJECTIVE: Tuberculosis is a major public health problem and most cases are concentrated in vulnerable populations. The objective was to describe the incidence rates trend in native and foreign population (2009-2018) in Madrid Region. METHODS: Retrospective analysis of cases from the Tuberculosis Regional Registry of cases of Madrid Region 2009-2018. Annual incidence rates were calculated by country of birth (Spain, other), sex and age group (<15, 15-34, 35-44, 45-64, >64), using the annual January 1st continuous register population. The infection rate trend and the annual percentage change (APC) were calculated, along with the best jointpoint adjustment using Jointpoint regression. RESULTS: 7,696 cases were analyzed, 48.2% were foreign-born individuals. Average age in native population was 50 years old (SD: 23.96) and 35 (DS: 36.64) in foreign-born individuals (p < 0.001). The overall incidence rate decreased from 17.30 in 2009 to 9.00 per 100,000 in 2018 and was higher in men. Pulmonary tuberculosis reduced from 11.90 to 6.55. Among native population, the incidence of TB fell from 10.29 to 5.24 with an APC of -7.3% (95%IC: -8.9; -5.7) (p < 0.05), no jointpoint was identified. Among foreign-born individuals the incidence of tuberculosis declined from 46.54 to 25.49, a joint point was identified in 2013, observing an incidence decrease for the period 2009-2013 and APC of -13.8% (IC95%: -17.5; -10.0). CONCLUSIONS: The global incidence rate in this period has decreased by approximately 7% per year. However, this reduction occurred mainly in native population. In foreign-born individuals the incidence decreased by approximately 14% during the 2009-2013 period, after this period there have been no significant incidence changes

Community-wide measles outbreak in the Region of Madrid, Spain, 10 years after the implementation of the Elimination Plan, 2011-2012.

We describe a community-wide outbreak of measles due to a D4 genotype virus that took place in the Region of Madrid, Spain, between February 2011 and August 2012, along with the control measures adopted. The following variables were collected: date of birth, sex, symptoms, complications, hospital admission, laboratory test results, link with another cases, home address, places of work or study, travel during the incubation period, ethnic group, and Mumps-Measles-Rubella (MMR) vaccination status. Incidences were calculated by 100,000 inhabitants. A total of 789 cases were identified. Of all cases, 36.0% belonged to Roma community, among which 68.7% were 16 months to 19 y old. Non-Roma cases were predominantly patients from 6 to 15 months (28.1%) and 20 to 39 y (52.3%). Most cases were unvaccinated. We found out that 3.0% of cases were healthcare workers. The first vaccination dose was brought forward to 12 months, active recruitment of unvaccinated children from 12 months to 4 y of age was performed and the vaccination of healthcare workers and of members of the Roma community was reinforced. High vaccination coverage must be reached with 2 doses of MMR vaccine, aimed at specific groups, such as young adults, Roma population and healthcare workers.

Seroprevalence of measles and rubella virus antibodies in the population of the Community of Madrid, 2008-2009.

The seroprevalence (SP) of measles and rubella virus antibodies is presented by age groups obtained in the IV Serosurvey of the Region of Madrid (2008-2009). The target population is composed of residents with ages ranging between 2 and 60 years in the Region of Madrid. A two-stage cluster sample is used. The SP of measles virus antibodies is 97.8% (CI 95%: 97.3-98.2). The highest SP is observed in the 2-5 year and 41-60 year age groups. The point estimate does not reach 95% in the 16-20 and 21-30 year age groups. The SP of rubella virus antibodies is 97.2% (CI 95%: 96.5-97.7). The SP is over 95% in all of the age groups. In immigrant women between the ages of 16 and 49, the SP is 95.9% (CI 95%: 93.7-97.4). The identification of groups susceptible to the measles virus in young adults could lead to outbreaks as a result of importing the virus. The circulation of the rubella virus is possible among immigrant women aged between 16 and 49 years, which could lead to the appearance of SRC cases. Epidemiological surveillance will allow the impact on the measles and rubella elimination plan to be determined in the future.

Effectiveness of 23-valent pneumococcal polysaccharide vaccine in adults aged 60 years and over in the Region of Madrid, Spain, 2008-2011.

Invasive pneumococcal disease (IPD) is a notifiable disease in the Region of Madrid. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for children and adults aged two years or over with a high risk of disease, and for all adults aged 60 and over. We describe the evolution of IPD incidence from 2008 to 2011 in people aged 60 years and over and PPV23 vaccine effectiveness (VE). VE is estimated using both the screening method and indirect cohort method. The incidence of IPD varied from 20.0 in 2008 to 15.2 per 100,000 inhabitants in 2011 (RR: 0.8; 95% CI: 0.6­0.9). Adjusted VE estimated with the screening method was 68.2% (95% CI: 56.2­76.9). VE with the Broome method was 44.5% (95% CI: 23.8­59.6) for all PPV23 serotypes, and 64.4% (95% CI: 45.2­76.8) for PPV23 serotypes not included in conjugate vaccines. VE was lower in patients aged 80 years and older (25.5%; 95% CI:-23.2 to 55.0) and those with highrisk medical conditions (31.7%; 95% CI: -2.2 to -54.4). Adjusted VE was 44.5% (95% CI: 19.4-61.8) within 5 years of vaccination and 32.5% (95% CI: -5.6 to 56.9) after 5 years. These results are compatible with current recommendations for PPV23.

Vigilancia de la varicela en la Comunidad de Madrid a través de la red de médicos centinela 2002-2005 / Surveillance of varicella in Madrid Autonomous Region through the sentinel practice newtwork for the period 2002-2005

La varicela es la enfermedad primaria causada porel virus varicela-zoster. Es muy contagiosa y frecuenteen niños. En ausencia de vacunación, la mayoríade la población la padece. Objetivo: describir lasituación de la varicela en la Comunidad de Madriddurante los años 2002 a 2005 a través de la Red deMédicos Centinela de la Comunidad de Madrid.Fuente de datos: Red de médicos Centinela de laComunidad de Madrid, que recoge casos de varicelade forma individualizada, desde 2002 a 2005. Se calcularonlas incidencias acumuladas semanales, tasasde incidencia cruda y estandarizada y tasas específicaspor grupos de edad, para cada año, de varicela.Las tasas estandarizadas de incidencia anual devaricela oscilaron entre 587,1 y 1239,6 casos por100000 personas-año, con una notable disminuciónde la incidencia en el año 2005. La mayoría de loscasos se dio en niños. Se observó una periodicidadanual. La forma más frecuente de exposición es elcontacto con otro caso de varicela, y lugar de exposiciónmás común, la guardería o el colegio.En ausencia de vacunación, la incidencia de varicelano ha sufrido cambios significativos en los últimosaños, a excepción del descenso en el año2005. Son necesarios más estudios para determinarla causa de dicho descenso y para evaluar la efectividadde la vacunación contra la varicela. Las redesde médicos centinela son un instrumento válido parala vigilancia de enfermedades como la varicela

Varicella (chickenpox) is the primary disease causedby varicella-zoster virus. It is extremely contagiousand is frequent in children. Indeed, in the absence ofvaccination, most of the population is liable to contractit. The aim of this study is to describe the status for varicellain the Madrid Autonomous Region through theSentinel Practice Network, since 2002 to 2005.Data source: individualised varicella case recordskept by the Madrid Autonomous Region SentinelPractice Network for the period 2002-2005. Cumulativeincidences, crude and standardised incidencerates, and age-specific rates of varicella were calculatedfor each year.Standardised annual varicella incidence rates rangedfrom 587.1 to 1239.6 cases per 100 000 personyears.Most cases affected children. Varicella incidencedisplayed an annual periodicity. The most frequentexposure was the contact with other chickenpoxcases, and the most common place of exposurewas school.In the absence of vaccination, no significant changesin varicella incidence were in evidence recentyears, except the decrease in 2005. Further studiesare needed to assess such decrease and to assessvaccination efficacy. Sentinel practice networks area valid instrument for surveillance of diseases suchas varicella

[Prevalence of tuberculosis infection and its association with social class in children in the Autonomous Community of Madrid]. / Prevalencia de infección tuberculosa y su relación con la clase social en niños de la Comunidad de Madrid.

INTRODUCTION: The frequency of tuberculosis infection, particularly among children, indicates the magnitude of the disease reservoir. The aim of this study was to ascertain the prevalence of tuberculosis infection in children in the Autonomous Community of Madrid and its association with social class. MATERIAL AND METHODS: We performed a cross sectional study of 6-year-old schoolchildren living in the Autonomous Community of Madrid, selected through probabilistic sampling. From September 1999 through June 2000, information was collected on residence stratum, tuberculin test (positivity threshold 5 mm), social class (five categories), based on the occupation of the main earner in the family, and the formal education attained by the parents. We calculated 95% confidence intervals for the prevalence estimates according to a Poisson distribution. RESULTS: A total of 2,721 children were studied. The prevalence of tuberculosis infection for the total study population was 0.62% (95% CI: 0.29-0.95). The prevalence of tuberculosis infection was 0.42% (95% CI: 0.00-0.85) in social class I (the highest), 0.00% (95% CI: 0.00-1.17) in class II, 0.77% (95% CI: 0.00-1.86) in class III, 0.62% (95% CI: 0.00-1.32) in class IV, and 1.57% (95% CI: 0.00-3.40) in class V (the lowest). In both fathers and mothers, the highest prevalence of tuberculosis infection was found in the group that had only completed elementary school or basic general education (up to the age of 14). CONCLUSIONS: The prevalence of tuberculosis infection in the Autonomous Community of Madrid is similar to that in others areas of Spain. The results of our study are consistent with a lower prevalence in the higher socioeconomic groups.

Prevalencia de infección tuberculosa y su relación con la clase social en niños de la Comunidad de Madrid / Prevalence of tuberculosis infection and its association with social class in children in the Autonomous Community of Madrid

Introducción La frecuencia de infección tuberculosa, sobre todo en población infantil, indica la magnitud del reservorio de la enfermedad. El objetivo de este trabajo fue medir la prevalencia de infección tuberculosa en niños de la Comunidad de Madrid y su asociación con la clase social de pertenencia. Material y métodos Se realizó un estudio transversal de los niños de 6 años escolarizados y residentes en la Comunidad de Madrid, seleccionados mediante muestreo probabilístico. Entre septiembre y junio de 2000, se obtuvo información sobre estrato de residencia, resultado de la prueba de la tuberculina (umbral de positividad de 5 mm), clase social (en 5 categorías) estimada por la ocupación del sustentador principal del hogar, y los estudios realizados por el padre y por la madre. Se realizaron estimaciones al 95 % de confianza (IC 95 %) a partir de una distribución de Poisson. Resultados Se han estudiado 2.721 niños. La prevalencia de infección tuberculosa en el total de la población de estudio fue 0,62 % (IC 95 %: 0,29-0,95). Por clase social, la prevalencia ha sido 0,42 % (IC 95 %: 0,00-0,85) en la clase I (la más alta), 0,00 % (IC 95 %: 0,00-1,17) en la clase II, 0,77 % (IC 95 %: 0,00-1,86) en la clase III, 0,62 % (IC 95 %: 0,00-1,32) en la clase IV, y 1,57 % (IC 95 %: 0,00-3,40) en la clase V (la más baja). En los padres y madres, la prevalencia de infección tuberculosa más elevada correspondió al grupo que ha completado el bachiller elemental/EGB. Conclusiones La prevalencia de infección tuberculosa en la Comunidad de Madrid es similar a la observada en otras zonas de España. Los resultados son consistentes con una menor prevalencia en los grupos con nivel socioeconómico más elevado

Introduction The frequency of tuberculosis infection, particularly among children, indicates the magnitude of the disease reservoir. The aim of this study was to ascertain the prevalence of tuberculosis infection in children in the Autonomous Community of Madrid and its association with social class. Material and methods We performed a cross sectional study of 6-year-old schoolchildren living in the Autonomous Community of Madrid, selected through probabilistic sampling. From September 1999 through June 2000, information was collected on residence stratum, tuberculin test (positivity threshold 5 mm), social class (five categories), based on the occupation of the main earner in the family, and the formal education attained by the parents. We calculated 95 % confidence intervals for the prevalence estimates according to a Poisson distribution. Results A total of 2,721 children were studied. The prevalence of tuberculosis infection for the total study population was 0.62 % (95 % CI: 0.29-0.95). The prevalence of tuberculosis infection was 0.42 % (95 % CI: 0.00-0.85) in social class I (the highest), 0.00 % (95 % CI: 0.00-1.17) in class II, 0.77 % (95 % CI: 0.00-1.86) in class III, 0.62 % (95 % CI: 0.00-1.32) in class IV, and 1.57 % (95 % CI: 0.00-3.40) in class V (the lowest). In both fathers and mothers, the highest prevalence of tuberculosis infection was found in the group that had only completed elementary school or basic general education (up to the age of 14). Conclusions The prevalence of tuberculosis infection in the Autonomous Community of Madrid is similar to that in others areas of Spain. The results of our study are consistent with a lower prevalence in the higher socioeconomic groups