A case-control study to assess the effectiveness of pertussis vaccination during pregnancy on newborns, Valencian community, Spain, 1 March 2015 to 29 February 2016.

In the Valencian Community (Spain), the programme of maternal pertussis vaccination during pregnancy started in January 2015. The objective of this study was to estimate in this region the vaccine effectiveness (VE) in protecting newborns against laboratory-confirmed pertussis infection. A matched case-control study was undertaken in the period between 1 March 2015 and 29 February 2016. Twenty-two cases and 66 controls (+/- 15 days of age difference) were included in the study. Cases were non-vaccinated infants < 3 months of age at disease onset testing positive for pertussis by real-time PCR. For every case three unvaccinated controls were selected. Odds ratios (OR) were calculated by multiple conditional logistic regression for association between maternal vaccination and infant pertussis. Other children in the household, as well as mother- and environmental covariates were taken into account. The VE was calculated as 1 - OR. Mothers of five cases (23%) and of 41 controls (62%) were vaccinated during pregnancy. The adjusted VE was 90.9% (95% confidence interval (CI): 56.6 to 98.1). The only covariate in the final model was breastfeeding (protective effect). Our study provides evidence in favour of pertussis vaccination programmes for pregnant women in order to prevent whooping cough in infants aged less than 3 months.

Reemergencia del sarampión. Situación epidémica en la Comunidad Valenciana durante los años 2011 y 2012 / Reemergence of measles. Epidemic situation in the Valencian Community during the years 2011 and 2012

La incidencia del sarampión descendió hasta llegar a ser una notificación esporádica e infrecuente en la última década. La reemergencia de la enfermedad alcanzó 744 casos en 2012, tasa de 14,50 × 105 habitantes. Se aplicó un diseño clásico en Vigilancia de Salud Pública: análisis retrospectivo de incidencia acumulada y características de los sujetos afectados. Se cruzaron los datos de encuesta con los de la Red Microbiológica Valenciana (RedMIVA). En total, 976 casos de sarampión fueron confirmados en el período epidémico 2011-2012. La distribución temporal muestra 3 ondas de amplitud constante: 12 a 15 semanas. La proporción de sujetos no vacunados y con estado vacunal desconocido alcanzó el 85% de los casos. Se documentaron 25 brotes, 499 casos asociados; en 7 de 10 brotes comunitarios, el inicio ocurrió en población de etnia gitana sin vacunar. En la ciudad de Valencia se aplicó profilaxis postexposición en 32 colegios, observándose bajas coberturas, entre el 63 y el 77%, en 8 centros e inferiores al 50% en 4. La tasa de serologías negativas fue del 12,4%, destacando los menores de 16 meses con el 44,8%. Las cohortes de 20 a 59 años presentaron tasas de negatividad del 13,5 al 5,9%. La epidemia tuvo su origen en la importación de casos a un territorio con insuficiente protección inmunitaria contra el sarampión. Su impacto y desarrollo estuvo condicionado por la cobertura vacunal previa, el patrón social y étnico de diferentes territorios y barrios, y la aplicación extensiva de profilaxis postexposición a contactos escolares y familiares de casos

Measles incidence declined until becomes a sporadic reporting and infrequent notification in the last decade. The reemergence of the disease reached 744 cases in 2012, a rate of 14.50 × 105 inhabitants. A classic design in Public Health Surveillance was performed: retrospective analysis of cumulative incidence and characteristics of the affected subjects. Those dates were in record linkage with Valencia Microbiology Network (RedMIVA). Finally, 976 cases of measles were confirmed in 2011-2012 epidemic period. Time-line distribution shows three waves with amplitude length on 12-15 weeks. Proportion of unvaccinated or unknown subjects came up to 85% of cases. 25 outbreaks were reported, 499 cases associated. In 7 of the 10 community outbreaks early cases were from Roma population unvaccinated. In the city of Valencia was applied post-exposure prophylaxis in 32 schools and was observed low coverage: between 63% and 77% in 8 schools and less than 50% in 4. Serum negative rate was 12.4% and we highlight the rate under 16 months: 44.8%. Cohorts of 20- 59 years had negative rates between 13.5 to 5.9%. The origin of the epidemic was the importation of cases to a territory with inadequate immune protection against measles. Its impact and development was conditioned by previous immunization coverage, the social and ethnic pattern of different areas or quarters and the extensive application of post-exposure prophylaxis at school and family contacts of cases

Reemergencia del sarampión. Situación epidémica en la Comunidad Valenciana durante los años 2011 y 2012 / Reemergence of measles. Epidemic situation in the Valencian Community during the years 2011 and 2012

La incidencia del sarampión descendió hasta llegar a ser una notificación esporádica e infrecuente en la última década. La reemergencia de la enfermedad alcanzó 744 casos en 2012, tasa de 14,50 × 105habitantes.Se aplicó un diseño clásico en Vigilancia de Salud Pública: análisis retrospectivo de incidencia acumulada y características de los sujetos afectados. Se cruzaron los datos de encuesta con los de la Red Microbiológica Valenciana (RedMIVA).En total, 976 casos de sarampión fueron confirmados en el período epidémico 2011-2012. La distribución temporal muestra 3 ondas de amplitud constante: 12 a 15 semanas. La proporción de sujetos no vacunados y con estado vacunal desconocido alcanzó el 85% de los casos. Se documentaron 25 brotes, 499 casos asociados; en 7 de 10 brotes comunitarios, el inicio ocurrió en población de etnia gitana sin vacunar. En la ciudad de Valencia se aplicó profilaxis postexposición en 32 colegios, observándose bajas coberturas, entre el 63 y el 77%, en 8 centros e inferiores al 50% en 4. La tasa de serologías negativas fue del 12,4%, destacando los menores de 16 meses con el 44,8%. Las cohortes de 20 a 59 años presentaron tasas de negatividad del 13,5 al 5,9%.La epidemia tuvo su origen en la importación de casos a un territorio con insuficiente protección inmunitaria contra el sarampión. Su impacto y desarrollo estuvo condicionado por la cobertura vacunal previa, el patrón social y étnico de diferentes territorios y barrios, y la aplicación extensiva de profilaxis postexposición a contactos escolares y familiares de casos (AU)

Measles incidence declined until becomes a sporadic reporting and infrequent notification in the last decade. The reemergence of the disease reached 744 cases in 2012, a rate of 14.50 × 105 inhabitants. A classic design in Public Health Surveillance was performed: retrospective analysis of cumulative incidence and characteristics of the affected subjects. Those dates were in record linkage with Valencia Microbiology Network (RedMIVA).Finally, 976 cases of measles were confirmed in 2011-2012 epidemic period. Time-line distribution shows three waves with amplitude length on 12-15 weeks. Proportion of unvaccinated or unknown subjects came up to 85% of cases. 25 outbreaks were reported, 499 cases associated. In 7 of the 10 community outbreaks early cases were from Roma population unvaccinated. In the city of Valencia was applied post-exposure prophylaxis in 32 schools and was observed low coverage: between 63% and 77% in 8 schools and less than 50% in 4. Serum negative rate was 12.4% and we highlight the rate under 16 months: 44.8%. Cohorts of 20-59 years had negative rates between 13.5 to 5.9%.The origin of the epidemic was the importation of cases to a territory with inadequate immune protection against measles. Its impact and development was conditioned by previous immunization coverage, the social and ethnic pattern of different areas or quarters and the extensive application of post-exposure prophylaxis at school and family contacts of cases (AU)

Vigilancia de la gripe pandémica en la Comunidad Valenciana y vacuna antigripal estacional / Pandemic influenza surveillance in the Valencian community and seasonal influenza vaccines

Fundamento: En la Comunidad Valenciana se ha llevado a cabo la vigilancia de la Gripe pandémica. Algunos estudios sobre efectividad de la vacuna estacional para Gripe AnH1N1 han presentado resultados no consistentes. El objetivo del trabajo es describir los resultados de la vigilancia epidemiológica y la efectividad de la vacuna estacional para Gripe pandémica en las semanas 28 a 51 de 2009. Métodos: Se estudiaron los casos en atención primaria, hospitalizados confirmados, aislamientos virales y reacción de la cadena de la polimerasa (PCR) y coberturas vacunales. Se calculó la efectividad vacunal por el método de screening de Farrington, en tres grupos de edad y dos periodos: vacunados de las temporadas 2008-9 y 2009-10. Resultados: En el primer periodo (semanas 28 a 40) los casos se concentraron en el grupo de 15 a 64 años (7.207 casos), seguido de los menores de 15 años (1.596 casos). En el segundo periodo (semanas 45 a 47) afectó más a menores de 15 años (28.218 casos). En ambos periodos las tasas de incidencia en mayores de 65 años fue de 56,3 y 125,1 respectivamente. En el periodo estudiado (semanas 28 a 51) se confirmaron 5.481 casos de los que 1.746 (31,8%) fueron hospitalizados. La curva de personas hospitalizadas presentaba un perfil similar al de atención primaria, y también el seguimiento microbiológico del virus. La efectividad vacunal en el segundo periodo fue del 25% en adultos entre 15 y 64 años y del 51% en mayores de 64 años. Conclusiones: Se observó una protección edad dependiente con efectividad vacunal positiva en los mayores de 64 años, aunque puede estar confundida por exposición natural al virus, vacunas previas y o respuesta inmunitaria(AU)

Background: Surveillance of Pandemic influenza was carried out in the Valencian Community. Some effectiveness studies of the seasonal vaccine for AnH1N1 virus have presented no consistent results. The objective of the work consists on describing the results of the epidemic surveillance and effectiveness of the seasonal vaccine for pandemic influenza in the weeks 28 to 51, 2009. Methods: We studied the cases in primary care, hospitalized confirmed, Polimerase Chain Reaction (PCR) and viral isolates and vaccine coverage. Vaccine effectiveness was calculated by the Farrington method of screening method, in three age groups, and two periods: vaccinated 2008-9 and 2009-10 seasons. Results: In the first period (weeks 28-40) the incidence rates were highest in the group of 15-64 years (7207 cases), followed by those under 15 years (1596 cases). In the second period (weeks 45-47) children under 15 years (28218 cases) were the most affected. In both periods incidence in patients older than 65 years was low (rates of 56,3 and 125,1 respectively). In the studied period (weeks 28 at 51) 5481 cases were confirmed, of those that 1746 (31,8%) were hospitalized. The curve of hospitalization rate showed a profile similar to those in primary care and also in microbiological surveillance of the virus. The vaccine effectiveness in the second period was 25% in adults between 15 and 64 years and 51% in those older than 64 years. Conclusions: There is an age-dependent protection with positive vaccine efficacy in the elderly, although it may be confounded by natural exposure to the virus, previous immunizations or immune response(AU)

[Pandemic influenza surveillance in the valencian community and seasonal influenza vaccines]. / Vigilancia de la gripe pandémica en la Comunidad Valenciana y vacuna antigripal estacional.

BACKGROUND: Surveillance of Pandemic influenza was carried out in the Valencian Community. Some effectiveness studies of the seasonal vaccine for AnH1N1 virus have presented no consistent results. The objective of the work consists on describing the results of the epidemic surveillance and effectiveness of the seasonal vaccine for pandemic influenza in the weeks 28 to 51, 2009. METHODS: We studied the cases in primary care, hospitalized confirmed, Polimerase Chain Reaction (PCR) and viral isolates and vaccine coverage. Vaccine effectiveness was calculated by the Farrington method of screening method, in three age groups, and two periods: vaccinated 2008-9 and 2009-10 seasons. RESULTS: In the first period (weeks 28-40) the incidence rates were highest in the group of 15-64 years (7207 cases), followed by those under 15 years (1596 cases). In the second period (weeks 45-47) children under 15 years (28218 cases) were the most affected. In both periods incidence in patients older than 65 years was low (rates of 56,3 and 125,1 respectively). In the studied period (weeks 28 at 51) 5481 cases were confirmed, of those that 1746 (31,8%) were hospitalized. The curve of hospitalization rate showed a profile similar to those in primary care and also in microbiological surveillance of the virus. The vaccine effectiveness in the second period was 25% in adults between 15 and 64 years and 51% in those older than 64 years. CONCLUSIONS: There is an age-dependent protection with positive vaccine efficacy in the elderly, although it may be confounded by natural exposure to the virus, previous immunizations or immune response.

[Outbreak of Salmonella enteriditis food poisoning at a dining hall facility]. / Brote de toxiinfección alimentaria por Salmonella entérica en un establecimiento de restauración colectiva.

BACKGROUND: An outbreak of Salmonella enteriditis food poisoning having occurred at two banquet halls, affecting eight groups of guests, is described. This research was aimed at determining the food by means of which this illness was transmitted. METHODS: An analysis was conducted of the food processing procedures subject to having caused the outbreak. The association of the foods with the illness was analyzed by means of a case and control design. The adjusted Odds Ratio (aOR) and the 95% confidence intervals (C195%) were calculated by logic regression. RESULTS: The guests totalled 1771 in number, being divided up into 13 groups for three days running. A total of 629 individuals (36%) were surveyed The probable cases totalled 250 in number, 61 confirmed by Salmonella enterica. The glazed biscuit (dessert with raw egg having undergone no heat processing) showed the highest adjusted Odds Ratio (aOR = 20.40; CI95%:7.52-55.30) and tested positive for Salmonella enterica of the enteritidis serotype. CONCLUSIONS: Epidemiological and laboratory evidence supports the glazed biscuit having been the contaminated food having caused the outbreak. The research stressed as contributing factors: the use of raw egg, the production of large quantities ahead of time, prior to the time at which the food item in question was to be eaten.

Brote de toxiinfección alimentaria por salmonella entérica en un establecimiento de restauración colectiva / Outbreak of Salmonella Enteriditis Food Poisoning at a Dining Hall Facility

Fundamento: Se describe un brote de toxiinfección alimentariapor Salmonella enteritidis ocurrido en dos salones de banquetes conocho grupos de comensales afectados. El objeto de la investigaciónfue determinar el alimento vehículo de transmisión de la enfermedad.Métodos: Se analizaron los procesos de elaboración de los alimentossusceptibles de haber causado el brote. La asociación de losalimentos con la enfermedad se analizó mediante un diseño de casosy controles. Se calcularon las Odds Ratio ajustadas (ORa) y sus intervalosde confianza al 95% (IC95%) por regresión logística.Resultados: El número de comensales fue 1.771, distribuidos en13 grupos durante tres días consecutivos. Se encuestó a 629 personas(36%). El número de casos probables fue de 250, 61 confirmados porsalmonella enterica. El biscuit glasé (postre con huevo crudo sin tratamientotérmico) presentó la Odds Ratio ajustada más alta (ORa =20,40; IC95%:7,52-55,30) y fue positivo a Salmonella enterica serotipoenteritidis.Conclusiones: Existe evidencia epidemiológica y de laboratoriode que el biscuit glacé fue el alimento contaminado que causó el brote.La investigación destacó como factores contribuyentes la utilizaciónde huevo crudo, la producción en grandes cantidades y con antelaciónal consumo del alimento

Background: An outbreak of Salmonella enteriditis food poisoninghaving occurred at two banquet halls, affecting eight groupsof guests, is described. This research was aimed at determining thefood by means of which this illness was transmitted.Methods: An analysis was conducted of the food processingprocedures subject to having caused the outbreak. The association ofthe foods with the illness was analyzed by means of a case and controldesign. The adjusted Odds Ratio (aOR) and the 95% confidenceintervals (CI95%) were calculated by logic regression.Results: The guests totalled 1,771 in number, being divided upinto 13 groups for three days running. A total of 629 individuals(36%) were surveyed The probable cases totalled 250 in number, 61confirmed by Salmonella enterica.The glazed biscuit (dessert withraw egg having undergone no heat processing) showed the highestadjusted Odds Ratio (aOR = 20.40; CI95%:7.52-55.30) and testedpositive for Salmonella enterica of the enteritidis serotype.Conclusions: Epidemiological and laboratory evidence supportsthe glazed biscuit having been the contaminated food having causedthe outbreak. The research stressed as contributing factors: the useof raw egg, the production of large quantities ahead of time, prior tothe time at which the food item in question was to be eaten