Botulism in Spain: Epidemiology and Outcomes of Antitoxin Treatment, 1997-2019.

BACKGROUND: Botulism is a low incidence but potentially fatal infectious disease caused by neurotoxins produced mainly by Clostridium botulinum. There are different routes of acquisition, food-borne and infant/intestinal being the most frequent presentation, and antitoxin is the treatment of choice in all cases. In Spain, botulism is under surveillance, and case reporting is mandatory. METHODS: This retrospective study attempts to provide a more complete picture of the epidemiology of botulism in Spain from 1997 to 2019 and an assessment of the treatment, including the relationship between a delay in antitoxin administration and the length of hospitalization using the Cox proportional hazards test and Kruskal-Wallis test, and an approach to the frequency of adverse events, issues for which no previous national data have been published. RESULTS: Eight of the 44 outbreaks were associated with contaminated commercial foods involving ≤7 cases/outbreak; preserved vegetables were the main source of infection, followed by fish products; early antitoxin administration significantly reduces the hospital stay, and adverse reactions to the antitoxin affect around 3% of treated cases.

Imported cases of malaria in Spain: observational study using nationally reported statistics and surveillance data, 2002-2015.

BACKGROUND: Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD). METHODS: Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors. RESULTS: A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy. CONCLUSIONS: The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.

La enfermedad por virus Zika en España. Resultados de la vigilancia y epidemiología de los casos notificados en 2015-2017 / Zika virus disease in Spain. Surveillance results and epidemiology on reported cases, 2015-2017

Introducción y objetivo: La enfermedad por virus Zika constituye un reto para la salud pública por su rápida expansión y sus potenciales complicaciones fetales. En España la enfermedad por virus Zika es importada, aunque la presencia de Aedes albopictus no descarta su transmisión autóctona. La enfermedad por virus Zika y los casos congénitos se vigilan desde 2016. El objetivo es conocer su epidemiología y el resultado de la gestación en las embarazadas. Material y métodos: Estudio descriptivo de casos notificados a la Red Nacional de Vigilancia Epidemiológica (RENAVE) entre el 30/11/2015 y el 31/12/2017. La definición de caso y la encuesta se recogen en los protocolos de la RENAVE. Las variables fueron: fecha, comunidad autónoma (CC.AA.), clasificación, modo y lugar de infección, variables sociodemográficas, clínicas, microbiológicas, embarazo y su evolución. Se realizó un análisis descriptivo de los casos y su distribución según el resto de variables. Resultados: Diecisiete CC.AA. notificaron 512 casos, de los cuales 507 fueron no congénitos: 327 (64,5%) eran mujeres (52,5% en edad fértil); 403 casos (79,5%) correspondieron a 2016 y 193 (38,1%) residían en CC.AA. colonizadas por A. albopictus entre mayo y octubre. El 96,1% de casos importados se infectaron en América y el 51,7% en visitas familiares. Se detectaron 3 casos de infección congénita en 77 embarazadas. Conclusiones: La evolución de notificaciones mostró paralelismo con la de la epidemia en América. El grupo más numeroso de viajeros fue el de mujeres jóvenes que fueron a Latinoamérica en visitas familiares. El seguimiento de las embarazadas permitió identificar complicaciones fetales

Introduction and objective: Zika virus disease is a challenge for public health due to its rapid spread and potential foetal complications. Although it is imported in Spain, there is a risk of autochthonous transmission due to Aedes albopictus presence. Zika disease and congenital cases have been under surveillance since 2016. The objective of this study is to explore the epidemiology of disease and pregnancies result. Material and methods: A descriptive study was carried out into cases reported to the National Surveillance Network (RENAVE) during the 30/11/2015 to 31/12/2017 period. The case definition and the survey are included in the RENAVE protocol. The variables were: date; notifying region (Autonomous Community (AC)); pregnancy and its evolution; case classification; mode of transmission; country or region of infection; socio-demographical, clinical and microbiological data. A descriptive analysis of the cases and their distribution according to the other variables was carried out. Results: A total of 512 cases were reported by 17 ACs. 507 were non-congenital, of which 327 (64.5%) were women (52.5% of childbearing age). 403 cases (79.5%) corresponded to 2016 and 193 (38.1%) resided in regions with A. albopictus presence between May and October. 96.1% of imported cases were infected in America (51.7% while visiting relatives). Three cases (3.9%) of congenital Zika virus infection were detected among 77 pregnant women. Conclusions: The evolution of reported cases was in accordance with that of the epidemic in America. The largest group of travellers was young women who travelled to Latin America on family visits. Pregnancy monitoring resulted in the identification of Zika related foetal complications

Zika virus disease in Spain. Surveillance results and epidemiology on reported cases, 2015-2017. / La enfermedad por virus Zika en España. Resultados de la vigilancia y epidemiología de los casos notificados en 2015-2017.

INTRODUCTION AND OBJECTIVE: Zika virus disease is a challenge for public health due to its rapid spread and potential foetal complications. Although it is imported in Spain, there is a risk of autochthonous transmission due to Aedes albopictus presence. Zika disease and congenital cases have been under surveillance since 2016. The objective of this study is to explore the epidemiology of disease and pregnancies result. MATERIAL AND METHODS: A descriptive study was carried out into cases reported to the National Surveillance Network (RENAVE) during the 30/11/2015 to 31/12/2017 period. The case definition and the survey are included in the RENAVE protocol. The variables were: date; notifying region (Autonomous Community (AC)); pregnancy and its evolution; case classification; mode of transmission; country or region of infection; socio-demographical, clinical and microbiological data. A descriptive analysis of the cases and their distribution according to the other variables was carried out. RESULTS: A total of 512 cases were reported by 17 ACs. 507 were non-congenital, of which 327 (64.5%) were women (52.5% of childbearing age). 403 cases (79.5%) corresponded to 2016 and 193 (38.1%) resided in regions with A. albopictus presence between May and October. 96.1% of imported cases were infected in America (51.7% while visiting relatives). Three cases (3.9%) of congenital Zika virus infection were detected among 77 pregnant women. CONCLUSIONS: The evolution of reported cases was in accordance with that of the epidemic in America. The largest group of travellers was young women who travelled to Latin America on family visits. Pregnancy monitoring resulted in the identification of Zika related foetal complications.

[Zika virus epidemic. The Public Health response in Spain]. / Epidemia por virus Zika. Respuesta desde la salud púbica en España.

By mid-2015, an increase in the number of cases of microcephaly among newborns and neurologic disorders was detected in the Northwest of Brazil, which was possibly associated with Zika virus infection. Later on, this phenomenon was also observed in several Latin-American countries. In February 2016, the World Health Organization (WHO) on this basis, declared a Public Health Emergency of International Concern. From that moment on, several measures were adopted to achieve the epidemic control at both international and national levels. The WHO launched a strategic response plan based on case detection, infection control and treatment, as well as, the research and development of new vector control tools, diagnostic tests and vaccines. In Europe both surveillance and vector control systems were reinforced. The countries reporting most cases were France, Spain and the United Kingdom. In Spain, due to the high probability of case importation based on the close relationships with Latin-America, numerous measures were adopted to achieve a rapid response and an optimal control. Those included: the implementation of an active surveillance in collaboration with several experts, institutions and scientific societies; entomologic surveillance enhancement; the development of communication activities and recommendations for both healthcare workers and general population.

A mediados del 2015 se detectó en el noroeste de Brasil un incremento en el número de casos de microcefalia en recién nacidos y de alteraciones neurológicas, que se asociaron con una posible infección por el virus Zika y que más adelante comenzaría a observarse en otros países de Latinoamérica. En febrero de 2016 la Organización Mundial de la Salud (OMS) declaró esta situación como una Emergencia de Salud Pública de Importancia Internacional (ESPII) y desde ese momento se llevaron a cabo numerosas medidas para el control de la epidemia tanto a nivel internacional, como nacional en los diferentes países. La OMS lanzó un Plan de respuesta estratégico basado en la detección de casos, control de la infección y tratamiento, así como en la investigación y desarrollo de herramientas para el control de mosquitos, test diagnósticos y vacunas. En Europa se reforzaron los sistemas de vigilancia así como de control de los vectores, siendo los países que más casos notificaron: Francia, España y el Reino Unido. En España debido a la alta probabilidad de importación de casos por la estrecha relación con Latinoamérica, se llevaron a cabo numerosas medidas que permitieron una rápida respuesta y un óptimo control, que incluyeron: la puesta en marcha de una vigilancia activa en la que colaboraron diversos profesionales, organismos y sociedades científicas; el refuerzo de actividades de vigilancia entomológica; el desarrollo de actividades de comunicación y la elaboración de recomendaciones dirigidas a profesionales sanitarios y a la población general.

Epidemia por virus Zika. Respuesta desde la salud púbica en España / Zika virus epidemic. The Public Health response in Spain

A mediados del 2015 se detectó en el noroeste de Brasil un incremento en el número de casos de microcefalia en recién nacidos y de alteraciones neurológicas, que se asociaron con una posible infección por el virus Zika y que más adelante comenzaría a observarse en otros países de Latinoamérica. En febrero de 2016 la Organización Mundial de la Salud (OMS) declaró esta situación como una Emergencia de Salud Pública de Importancia Internacional (ESPII) y desde ese momento se llevaron a cabo numerosas medidas para el control de la epidemia tanto a nivel internacional, como nacional en los diferentes países. La OMS lanzó un Plan de respuesta estratégico basado en la detección de casos, control de la infección y tratamiento, así como en la investigación y desarrollo de herramientas para el control de mosquitos, test diagnósticos y vacunas. En Europa se reforzaron los sistemas de vigilancia así como de control de los vectores, siendo los países que más casos notificaron: Francia, España y el Reino Unido. En España debido a la alta probabilidad de importación de casos por la estrecha relación con Latinoamérica, se llevaron a cabo numerosas medidas que permitieron una rápida respuesta y un óptimo control, que incluyeron: la puesta en marcha de una vigilancia activa en la que colaboraron diversos profesionales, organismos y sociedades científicas; el refuerzo de actividades de vigilancia entomológica; el desarrollo de actividades de comunicación y la elaboración de recomendaciones dirigidas a profesionales sanitarios y a la población general

By mid-2015, an increase in the number of cases of microcephaly among newborns and neurologic disorders was detected in the Northwest of Brazil, which was possibly associated with Zika virus infection. Later on, this phenomenon was also observed in several Latin-American countries. In February 2016, the World Health Organization (WHO) on this basis, declared a Public Health Emergency of International Concern. From that moment on, several measures were adopted to achieve the epidemic control at both international and national levels. The WHO launched a strategic response plan based on case detection, infection control and treatment, as well as, the research and development of new vector control tools, diagnostic tests and vaccines. In Europe both surveillance and vector control systems were reinforced. The countries reporting most cases were France, Spain and the United Kingdom. In Spain, due to the high probability of case importation based on the close relationships with Latin-America, numerous measures were adopted to achieve a rapid response and an optimal control. Those included: the implementation of an active surveillance in collaboration with several experts, institutions and scientific societies; entomologic surveillance enhancement; the development of communication activities and recommendations for both healthcare workers and general population

[Risk Factors for Potentially Unsuccessful Results and Mortality during Tuberculosis Treatment in Spain]. / Factores de riesgo asociados a los resultados potencialmente insatisfactorios y a la mortalidad durante el tratamiento antituberculoso en España.

BACKGROUND: Successful result of treatment in 85% of cases is the target of a Tuberculosis (TB) Control Programme. The aim of this study is to determine the risk factors for unsuccessful completion of treatment and deaths of TB cases in Spain. METHODS: Data from the National Surveillance Epidemiological Network. Retrospective study including 5,880 TB cases reported in 2012. Outcomes were classified as: successful (S: cured and treatment completed), potentially unsuccessful (PU: failed, transferred, defaulted, still on treatment and unknown) and deaths. Logistic regression analysis was used to explore the association between epidemiological and clinical factors with PU and deaths as outcome variables. Two different models for nationals and foreigners were adjusted. RESULTS: Successful outcome was 81% in nationals and 79% in foreigners. Spanish TB cases had higher mortality rates than foreigners (8% vs. 2%), and lower percentage of transfers (2% vs. 6%). At multivariate level the risk factors for PU in nationals were: HIV coinfection (OR 1.6 CI95% 1.09-2.29) and previous treatment (OR 2.4 CI95% 1.67-3.53); and HIV coinfection (OR 1.7 CI95% 1.15-2.60), male sex (OR 1.4 CI95% 1.11-1.83) and pulmonary TB (OR 1.6 CI95% 1.22-2.09) in foreigners. Risk factors for death in nationals were: HIV coinfection (OR 2.7 CI95% 1.63-4.54), male sex (OR 1.4 CI95% 1.09-1.89), pulmonary TB (OR 1.5 CI95% 1.13-1.95) and an increasing risk with age (OR 8.9 CI95% 5.16-15.67 in over 45 years group.).; and HIV coinfection (OR 3.2 CI95% 1.53-6.76), male sex (OR 2.2 CI95% 1.01-4.60) and older age (OR 3.4 CI95% 1.81-6.48 in over 45 years group.) in foreigners. CONCLUSION: The rate of successful treatment in Spain does not meet the international target, especially in foreigners. To reduce unsuccessful treatment and deaths it is necessary to improve management in TB-HIV co-infected cases, and those with previous treatment story, pulmonary TB, males and older age.