Impact of a single-age cohort human papillomavirus vaccination strategy in Catalonia, Spain: Population-based analysis of anogenital warts in men and women.

Extensive multiple-age cohort human papillomavirus (HPV) vaccination has proved to be highly effective. We aimed to determine the 8-year population impact of a female single-age cohort HPV vaccination programme on the incidence of anogenital warts (AGW). In 2008, Catalonia initiated a school-based quadrivalent HPV vaccination programme targeting 11-year-old girls, achieving coverage over 80%. Data on diagnoses of AGW and genital herpes were obtained from a population-based database of electronic health records covering 74% of the population. The annual incidence rates from 2009 to 2016 were calculated, stratified by age and sex using Joinpoint regression to estimate trends and annual percentage changes (APC). Among women aged 16-19 years, the AGW incidence decreased by 61% from 2012 to 2016 (APC -19.4%; 95% CI: -30.0 to -7.3). In contrast, the incidence of genital herpes in same-aged women increased throughout the study period (APC 11.1%; 95% CI: 7.2-15.2). Among men aged 20-22 years, the increasing incidence of AGW shifted to a downward trend in 2013 (APC 2009-2013: 17.0%; 95% CI: 8.2-26.5; and APC 2013-2016: -4.5%; 95% CI: -14.6 to 6.9). A similar pattern was observed among men aged 23-25 years (APC 2009-2014: 16.0%; 95% CI: 12.0-20.2; and APC 2014-2016: -6.0%; 95% CI: -18.4 to 8.3). In contrast to AGW, among men aged 20-25 years, the incidence of genital herpes increased over this period. Our study strongly suggests that a single-cohort HPV vaccination strategy with high vaccine uptake not only provides direct benefit in the vaccinated cohorts but also extends protection through a herd effect to unvaccinated men.

Vaccines for the prevention of infections in adults: an opinion paper on the situation in Spain / Vacunas para la prevención de infecciones en adultos: artículo de opinión sobre la situación en España

The childhood immunization schedule is well known and generally well implemented in developed countries. For various reasons, the same is not true of vaccines aimed at preventing infections in adults, in which vaccination coverage is incomplete and generally very deficient. In order to assess the situation of adult vaccination in Spain, the Fundación de Ciencias de la Salud has brought together a series of experts in different fields, including doctors, nurses, representatives of patient associations, health managers and economists, health authorities and journalists to deal with this issue. The format was that of a round table in which a series of questions previously formulated by the coordinators were to be answered and debated. The document presented is not an exhaustive review of the topic, nor is it intended to make recommendations, but only to give a multidisciplinary opinion on topics that could be particularly debatable or controversial. The paper reviews the main vaccine-preventable adult diseases, their clinical and economic impact, the possibilities of reducing them with vaccination programmes and the difficulties in carrying them out. The role of nursing, pharmacy services, patient associations and the health administration itself in changing the current situation was discussed. Prospects for new vaccines were discussed and we speculated on the future in this field. Finally, particularly relevant ethical aspects in decision-making regarding vaccination were discussed, which must be faced by both individuals and states. We have tried to summarize, at the end of the presentation of each question, the environment of opinion that was agreed with all the members of the table

El calendario de vacunación infantil es bien conocido y generalmente bien implementado en los países desarrollados. Por varias razones, no ocurre lo mismo en el caso de las vacunas destinadas a prevenir las infecciones en adultos, en los que la cobertura vacunal es incompleta y generalmente muy deficiente. Con el fin de evaluar la situación de la vacunación de adultos en España, la Fundación de Ciencias de la Salud ha reunido a una serie de expertos en diferentes campos, incluyendo médicos, enfermeras, representantes de asociaciones de pacientes, gestores sanitarios, economistas, autoridades sanitarias y periodistas para discutir este asunto. El formato fue el de una mesa redonda en la que una serie de preguntas, formuladas previamente por los coordinadores, debían ser contestadas y debatidas. El documento presentado no es una revisión exhaustiva del tema, ni tiene por objeto hacer recomendaciones, simplemente pretende dar una opinión multidisciplinar sobre aspectos que pueden ser debatibles o controvertidos. El documento revisa las principales enfermedades de los adultos que pueden prevenirse con vacunas, su impacto clínico y económico, las posibilidades de reducirlos con los programas de vacunación y las dificultades para llevarlos a cabo. Se discutió el papel de la enfermería, la farmacia, los servicios de salud, las asociaciones de pacientes y la propia administración sanitaria para cambiar la situación actual. Se evaluaron las perspectivas para nuevas vacunas y se especuló sobre el futuro en este campo. Por último, se discutieron los aspectos éticos especialmente relevantes en la toma de decisiones con respecto a la vacunación, que deben ser afrontados tanto por los individuos como por los estados. Hemos intentado resumir, al final de la presentación de cada pregunta, la opinión que representaba el consenso de todos los miembros de la mesa

Effectiveness and impact of the hepatitis B vaccination program in preadolescents in Catalonia 21 years after its introduction.

Hepatitis B is a viral disease of global importance. In Catalonia in the 1980s, the seroepidemiological pattern of HBV infection was low-intermediate. In 1990, the Expert Committee on Vaccinations of the Department of Health of the Generalitat of Catalonia evaluated the systematic introduction of hepatitis B vaccination in preadolescents, maintaining the vaccination of risk groups. The objective of this study was to estimate the effectiveness and impact of the systematic hepatitis B vaccination programme in preadolescents in Catalonia 21 years after its introduction. A retrospective cohort study was conducted, comparing the disease incidence in vaccinated and unvaccinated cohorts. Cases of hepatitis B were defined as those reported by the General Subdirectorate of Surveillance and Response to Public Health Emergencies between 2000 and 2014. The incidence rate was 2.5 per 100,000 persons in 1991 and 1.2 per 100,000 persons in 2014, a reduction of 52%. During the study period, 388 cases of hepatitis B infection were notified, of which three were classified as vaccine failures. Vaccine effectiveness was 99.30% (95% CI: 97.83-99.78) and the population prevented fraction in the cohorts of preadolescents studied was 64.56% (95% CI: 60.45-68.66). The effectiveness and impact of the hepatitis B vaccination program in preadolescents in Catalonia is high, with the consequent benefits for the population.

Recomendaciones autonómicas en vacunación de hepatitis en adultos infectados por el virus de la inmunodeficiencia humana: ¿disparidad basada en la evidencia? / Regional recommendations on hepatitis vaccination in human immunodeficiency virus infected adult patients in Spain: evidence-based disparity?

No disponible

Seroprevalence study of B. pertussis infection in health care workers in Catalonia, Spain.

Pertussis is a re-emerging infection in countries with high infant immunization coverage. Healthcare workers (HCW) are exposed and can transmit the infection to especially-vulnerable patients. Therefore, pertussis vaccination of HCW is recommended. Between June 2008 and December 2010, 460 HCW from hospital and primary healthcare centers were recruited to determine susceptibility to pertussis. IgG antibodies against pertussis (anti-pertussis ab) were measured, using a routine technique that detects antibodies against pertussis including pertussis toxin (PT) and filamentous hemagglutinin (FHA). Positive results were confirmed with a more-specific technique that only assesses anti-PT IgG antibodies. The median age was 42 years (range, 21-65), 77.3% were female. 172 were nurses, 133 physicians, 60 other clinical workers and 95 non-clinical workers. None had received pertussis vaccination since childhood. The overall prevalence of anti-pertussis antibodies was 51.7%, (95% CI 47.1-56.4). Anti-PT antibodies were determined in the 220 HCW with positive anti-pertussis antibodies: 4 (1.8%) were negative and 33 (15%) had a high titer (≥ 45 IU/mL). No significant differences between the prevalence of anti-pertussis antibodies or anti-TP antibodies were found according to age, type of occupation or type of center. Our study confirms the need for vaccination of HCW because at least half are susceptible to pertussis. High anti-PT titers found in 15% of seropositive HCW showed that they had had recent contact with B. pertussis.

Are healthcare workers immune to rubella?

Healthcare workers (HCW) have high exposure to infectious diseases, some of which, such as rubella, are vaccine-preventable. The aim of this study was to determine the immunity of HCW against rubella. We performed a seroprevalence study using a self-administered survey and obtained blood samples to determine rubella Immunoglobulin G (IgG) antibody levels in HCW during preventive examinations by five Primary Care Basic Prevention Units and six tertiary hospitals in Catalonia. Informed consent was obtained. IgG was determined using an antibody capture microparticle direct chemiluminometric technique. The odss ratio (OR) and 95% confidence intervals (CI) were calculated. Logistic regression was made to calculate adjusted OR. Of 642 HCW who participated (29.9% physician, 38.8% nurses, 13.3% other health workers and 18% non-health workers), 46.6% were primary care workers and 53.4% hospital workers. Of total, 97.2% had rubella antibodies. HCW aged 30-44 years had a higher prevalence of antibodies (98.4%) compared with HCW aged<30 years (adjusted OR 3.92; 95% CI 1.04-14.85). The prevalence was higher in nurses than in other HCW (adjusted OR: 5.57, 95% CI 1.21-25.59). Antibody prevalence did not differ between females and males (97.4% vs. 97.1%, P 0.89), type of center (97.7% vs. 96.8%, P 0.51) or according to history of vaccination (97.3% vs. 96.8%, P 0.82). Seroprevalence of rubella antibodies is high in HCW, but workers aged<30 years have a higher susceptibility (5.5%). Vaccination should be reinforced in HCW in this age group, due to the risk of nosocomial transmission and congenital rubella.

Prevalence of measles antibodies among health care workers in Catalonia (Spain) in the elimination era.

BACKGROUND: Interruption of measles transmission was achieved in Catalonia (Spain) in 2000. Six years later, a measles outbreak occurred between August 2006 and June 2007 with 381 cases, 11 of whom were health care workers (HCW).The objective was to estimate susceptibility to measles in HCW and related demographic and occupational characteristics. METHODS: A measles seroprevalence study was carried out in 639 HCW from six public tertiary hospitals and five primary healthcare areas. Antibodies were tested using the Vircell Measles ELISA IgG Kit. Data were analyzed according to age, sex, type of HCW, type of centre and vaccination history.The odds ratios (OR) and their 95% CI were calculated to determine the variables associated with antibody prevalence. OR were adjusted using logistic regression.Positive predictive values (PPV) and the 95% confidence intervals (CI) of having two documented doses of a measles containing vaccine (MCV) for the presence of measles antibodies and of reporting a history of measles infection were calculated. RESULTS: The prevalence of measles antibodies in HCW was 98% (95% CI 96.6-98.9), and was lower in HCW born in 1981 or later, after the introduction of systematic paediatric vaccination (94.4%; 95% CI 86.4-98.5) and higher in HCW born between 1965 and 1980 (99.0%; 95% CI 97.0-99.8). Significant differences were found for HCW born in 1965-1980 with respect to those born in 1981 and after (adjusted OR of 5.67; 95% CI: 1.24-25.91).A total of 187 HCW reported being vaccinated: the proportion of vaccinated HCW decreased with age. Of HCW who reported being vaccinated, vaccination was confirmed by the vaccination card in 49%. Vaccination with 2 doses was documented in only 50 HCW, of whom 48 had measles antibodies. 311 HCW reported a history of measles.The PPV of having received two documented doses of MCV was 96% (95% CI 86.3-99.5) and the PPV of reporting a history of measles was 98.7% (95% CI 96.7-99.6). CONCLUSIONS: Screening to detect HCW who lack presumptive evidence of immunity and vaccination with two doses of vaccine should be reinforced, especially in young workers, to minimize the risk of contracting measles and infecting the susceptible patients they care for.

Serological survey of mumps immunity among health care workers in the Catalonia region of Spain.

Susceptible health care workers are at risk of acquiring and transmitting mumps to or from patients. A survey was carried out in 639 health care workers from tertiary public hospitals and primary care centers in the Catalonia region of Spain during 2009 to determine the prevalence of immunity to mumps among this group. The prevalence of immune health care workers was 87.5% (95% confidence interval, 84.7-89.9). Vaccination with 2 doses of vaccine should be reinforced in health care workers to minimize the risk of mumps transmission in health care settings.

Prevalence of susceptibility to tetanus and diphtheria in health care workers in Catalonia.

A seroprevalence study of tetanus and diphtheria was carried out in a sample of 537 health care workers in Catalonia. The prevalence of protective antibodies against tetanus was 93.9% (95% confidence interval: 91.5-95.7). The prevalence of protective antibodies against diphtheria was 46.4% (95% confidence interval: 42.1-50.7). Tetanus protection should be improved in health care workers born before 1975. The immune status against diphtheria was poor, with less than half of people born before 1975 correctly immunized.

High-risk travel abroad overtook low-risk travel from 1999 to 2004: characterization and trends in 2,622 Spanish travelers.

BACKGROUND: Travel medicine in Spain is provided by a few specialized centers that do not come under the auspices of the main health system. Some kind of reform is required to avoid common summer collapses and postponements of the service. In contrast to other European countries, neither the exact role nor the responsibilities of general practitioners and primary health care in travel medicine are clearly defined. METHODS: An observational study was performed with retrospective data concerning 2,622 travelers from 1999 to 2004. Although the study was performed at a third-level travel medicine center, continuous contact with and support to general practitioners was maintained throughout the period. RESULTS: International travel was a steadily increasing reality between 1999 and 2004 despite well-known tragic events involving world safety. The number of high-risk travels (53.4%) also increased and even overtook low-risk ones (46.6%). This trend was explained as the result of an increasing number of journeys to sub-Saharan Africa (14.9%) and those made by traveling immigrants (64.1% of those journeys), which represented a significantly higher proportion of high-risk travels compared with those made by autochthonous subjects (52.1%; p < .001). Moreover, traveling immigrants tend to consult more frequently in periods < 15 days prior to travel than do autochthonous travelers (p < .0001). A substantial number of highly vulnerable travelers, such as pregnant women, infants, elderly people, and immunosuppressed subjects, was found (1.8%). Low-risk travelers who could have been advised and vaccinated by general practitioners were 1,139 (43.4%). CONCLUSIONS: Given the increasing number of travelers undertaking high-risk travels abroad, any kind of reinforcement of travel medicine provision in Spain should be considered essential. General practitioners could attend to a significant proportion of low-risk travelers.

Caracterización de los peregrinos musulmanes procedentes de España: de Barcelona a Arabia Saudita / No disponible

Objetivo: 1. Caracterizar a los viajeros que se desplazan a Arabia Saudita con motivo de la peregrinación a los lugares santos islámicos (Hajj o Umra) y, 2. Determinar el riesgo del viaje en relación a una cohorte de inmigrantes viajeros a sus países de origen. Población y método: Se analizan datos procedentes de peregrinos (grupo H) durante el periodo 06/99-01/03 y se comparan con un grupo de inmigrantes viajeros consultantes durante el mismo periodo (grupo IV).Resultados: En el grupo H fueron identificados 23 viajeros-inmigrantes 15 (65,2%) y españoles 8 (34,8%)- .Tomaron parte en la Umra 13 (56,5%) y en el Hajj 10(43,5%). Habían residido por periodos > 2 años en Europa 19 (82,6%; IC95%: 67,3-97,9) y visitaron otro país 7 (30,4%). No se hallaron diferencias significativas entre los grupos H e IV en cuanto a días de duración del viaje y nº de viajes de riesgo. Los viajeros del grupo IV consultaron con mayor frecuencia en periodos < 15 días previos a la partida (p<0,001), lo que ello sugiere la existencia de mayor planificación y conocimiento de actividades preventivas del grupo H. Presentaron algún problema de salud el 8,6% del los viajeros del grupo H y el 23,1% del grupo IV. Conclusiones: Una parte sustancial de los peregrinos es de origen autóctono. Los peregrinos presentaron factores de riesgo para el desarrollo de problemas de salud en una proporción similar a la que presentan los inmigrantes que visitan sus países de origen (AU)

Objectives: 1. To characterize travelling people fulfilling the mandatory islamic obligation to visit the holy places in Saudi Arabia (Hajj or Umra) and, 2. To determine the risk of travel compared with a travelling immigrant to native country cohort. Method: Data recorded from travellers consulting to carryout some kind of pilgrimage to Saudi Arabia (group H)from 06/99 to 01/03 are analyzed and they were compared with a group of travelling immigrants during the same period (group IV).Results: In the group H 23 travellers were identified, of whom they were immigrants 15 (65.2%) and Spanish 8(34.8%). They carried out Umra 13 (56.5%) and Hajj10 (43.5%). They resided during periods > 2 years in Europe 19 (82.6%; IC 95%: 67.3-97.9) and they visited further countries 7 (30.4%). There where not significant differences between groups H and IV concerning lenght of journey and number of considered risk travels. Travellers from group IV consulted most frequently in periods < 15days prior to the journey (p<0.001), which suggests the existence of better planning and knowledge about pretravel preventive measures among group H. Any health problem abroad was recorded in 8.6% of group H and23.1% of group IV. Conclusions: A substantial part of islamic pilgrims have yet a spanish-native origin. Travelling pilgrims displayed risk factors to develop health problems in a similar proportion to which display the immigrants who visit their native countries (AU)