First autochthonous malaria case due to Plasmodium vivax since eradication, Spain, October 2010.

In October 2010, one case of autochthonous malaria due to Plasmodium vivax was diagnosed in Spain. The case occurred in Aragon, north-eastern Spain, where the vector Anopheles atroparvus is present. Although the source of infection could not be identified, this event highlights that sporadic autochthonous transmission of vector-borne diseases in continental Europe is possible and calls for enhanced surveillance and vector control measures.

Risk factors for disease severity among hospitalised patients with 2009 pandemic influenza A (H1N1) in Spain, April - December 2009.

We describe the clinical and epidemiological characteristics of patients hospitalised with confirmed 2009 pandemic influenza A(H1N1) in Spain from April to December 2009 and the risk factors associated with a worse outcome (admission to an intensive care unit or death) in adults. Case-based epidemiological information was collected as part of the national strategy for the surveillance of severe cases. Of 3,025 patients, 852 were admitted to an intensive care unit and overall, 200 died. The median patient age was 38 years (range: 0­94). A total of 662 (26%) patients had no underlying risk conditions. Antiviral therapy was initiated within 48 hours after symptom onset in only 35.2% (n=711); the median length of time before treatment was four days. In a multivariate analysis, the start of antiviral therapy more than 48 hours after symptom onset (odds ratio (OR) 2.39; 95% confidence interval (CI): 1.79 to 3.2), morbid obesity (OR: 2.01; 95% CI 1.38 to 2.94), cardiovascular disease (OR: 1.79; 95% CI: 1.2 to 2.67) and chronic obstructive pulmonary disease (OR: 1.51; 95% CI: 1.03 to 2.2) were significantly associated with a worse outcome in adults.

Influenza vaccination coverages among Spanish children, adults and health care workers.

BACKGROUND: This study aimed at describing influenza vaccination coverage among Spanish children, adults and health care workers (HCWs). PATIENTS AND METHODS: We analyzed 27,791 questionnaires on subjects aged 6 months or over, drawn from the 2003 Spanish National Health Survey. As the dependent variable, we took the answer to the question, "Did you (or your child) have a flu shot in the last campaign?". Independent variables were age group, gender, nationality, occupation (HCWs) and coexistence of chronic conditions. RESULTS: Overall influenza vaccination coverage for the total sample was 19.58%. Coverage for the pediatric population was 5.55%, with 20.74% of those with and 4.67% of those without chronic condition being vaccinated. Vaccination coverages were: 63.7% among subjects aged > or = 65 years; 30.5% among high-risk subjects aged < 65 years; and 19.65% among HCWs. CONCLUSIONS: We conclude that the available results show low levels of influenza vaccination coverage among high-risk subjects aged under 65 years, children in particular, and HCWs.

[Costs of accidental punctures in hospital health personnel]. / Costes de las inoculaciones accidentales en personal sanitario de un hospital.

OBJECTIVES: The aim of this study was to calculate the average cost of each hepatitis B, C and HIV follow-up carried out in the health personnel that have suffered an exposure to blood and body fluids and to estimate the cost for each of the different types of sources as well as to identify the items that account for the main part of the cost. METHODS: A cost analysis was carried out. The post-exposure programme was modelled in a decision tree combining probabilities (percentage of each type of source in dependence of its positivity for the three viruses and immunization state of the health personnel against hepatitis B) and monetary costs (pesetas from 1994). Costs included: salaries, laboratory, chemist, energy, cleaning, telephone, medical and office equipment, amortization and lost productivity. A sensitivity analysis was carried out with the real fulfillment of the programme. RESULTS: The average cost was 39,564 ptas. (29,750 ptas. applying the sensitivity analysis), with a range from 86,864 ptas. (source positive for the three viruses and injured subject not immunized) to 23,074 ptas. (source negative for the three viruses). If the source was hepatitis B positive, the average cost was 86,093 ptas. when the injured subject was not immunized and 53,232 ptas. if he was immunized. Serologic tests account for the main part of the cost (range from 72.8% to 87.7%). CONCLUSIONS: High cost suggests an appropriate risk evaluation in order to avoid unnecessary follow-ups. The model used allows to know the cost of each potentially avoided episode and it could be used for any hospital in order to make an economical evaluation of new preventive devices.

[Minimizing the costs of prescription of anti-infective drugs in two areas of primary health care]. / Un estudio de minimización de costes en la prescripción de antiinfecciosos en dos areas de atención primaria.

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was pesetas 8.547 bn in 1995. Expenditure on selected anti-infective drugs was pesetas 522 million (6.1% of the total). The overall saving estimated was 7.63% (pesetas 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.