Estimated incubation period distributions of mpox using cases from two international European festivals and outbreaks in a club in Berlin, May to June 2022.

BackgroundSince May 2022, an mpox outbreak affecting primarily men who have sex with men (MSM) has occurred in numerous non-endemic countries worldwide. As MSM frequently reported multiple sexual encounters in this outbreak, reliably determining the time of infection is difficult; consequently, estimation of the incubation period is challenging.AimWe aimed to provide valid and precise estimates of the incubation period distribution of mpox by using cases associated with early outbreak settings where infection likely occurred.MethodsColleagues in European countries were invited to provide information on exposure intervals and date of symptom onset for mpox cases who attended a fetish festival in Antwerp, Belgium, a gay pride festival in Gran Canaria, Spain or a particular club in Berlin, Germany, where early mpox outbreaks occurred. Cases of these outbreaks were pooled; doubly censored models using the log-normal, Weibull and Gamma distributions were fitted to estimate the incubation period distribution.ResultsWe included data on 122 laboratory-confirmed cases from 10 European countries. Depending on the distribution used, the median incubation period ranged between 8 and 9 days, with 5th and 95th percentiles ranging from 2 to 3 and from 20 to 23 days, respectively. The shortest interval that included 50% of incubation periods spanned 8 days (4-11 days).ConclusionCurrent public health management of close contacts should consider that in approximately 5% of cases, the incubation period exceeds the commonly used monitoring period of 21 days.

Post-exposure vaccine effectiveness and contact management in the mpox outbreak, Madrid, Spain, May to August 2022.

BackgroundAppropriate vaccination strategies have been key to controlling the outbreak of mpox outside endemic areas in 2022, yet few studies have provided information on mpox vaccine effectiveness (VE).AimTo assess VE after one dose of a third-generation smallpox vaccine against mpox when given as post-exposure prophylaxis (PEP) within 14 days.MethodsA survival analysis in a prospective cohort of close contacts of laboratory-confirmed mpox cases was conducted from the beginning of the outbreak in the region of Madrid in May 2022. The study included contacts of cases in this region diagnosed between 17 May and 15 August 2022. Follow up was up to 49 days. A multivariate proportional hazard model was used to evaluate VE in the presence of confounding and interaction.ResultsInformation was obtained from 484 close contacts, of which 230 were vaccinated within 14 days of exposure. Of the close contacts, 57 became ill during follow-up, eight vaccinated and 49 unvaccinated. The adjusted effectiveness of the vaccine was 88.8% (95% CI: 76.0-94.7). Among sexual contacts, VE was 93.6% (95% CI: 72.1-98.5) for non-cohabitants and 88.6% (95% CI: 66.1-96.2) for cohabitants.ConclusionPost-exposure prophylaxis of close contacts of mpox cases is an effective measure that can contribute to reducing the number of cases and eventually the symptoms of breakthrough infections. The continued use of PEP together with pre-exposure prophylaxis by vaccination and other population-targeted prevention measures are key factors in controlling an mpox outbreak.

Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022.

Up to 22 June 2022, 508 confirmed cases of monkeypox (MPX) have been reported in the Madrid region of Spain, 99% are men (n = 503) with a median age of 35 years (range: 18-67). In this ongoing outbreak, 427 cases (84.1%) reported condomless sex or sex with multiple partners within the 21 days before onset of symptoms, who were predominantly men who have sex with men (MSM) (n = 397; 93%). Both the location of the rash, mainly in the anogenital and perineal area, as well as the presence of inguinal lymphadenopathy suggest that close physical contact during sexual activity played a key role in transmission. Several cases reported being at a sauna in the city of Madrid (n = 34) or a mass event held on the Spanish island of Gran Canaria (n = 27), activities which may represent a conducive environment for MPX virus spread, with many private parties also playing an important role. Because of the rapid implementation of MPX surveillance in Madrid, one of the largest outbreaks reported outside Africa was identified. To minimise transmission, we continue to actively work with LGBTIQ+ groups and associations, with the aim of raising awareness among people at risk and encouraging them to adopt preventive measures.

[Community outbreak of hepatitis A in a marginal population. Vaccination for its control and acceptance of the measure]. / Brote comunitario de hepatitis A en un poblado marginal. Vacunación para su control y aceptación de la medida.

OBJECTIVE: To study a community outbreak of hepatitis A in a marginal population and the public health response in order to bring it under control. DESIGN: Descriptive study of the outbreak that occurred in February-June, 2004. An epidemiological survey was conducted to detect prior cases and active vigilance was set up. Case and susceptibility definitions were established. SETTING: A gypsy population in Madrid, Spain. They had basic provision of sewerage, water supply and waste disposal. PARTICIPANTS: A population of 550 in census; estimated population, 800. 70% were under 40 and 55% were illiterate. INTERVENTIONS: Control measures were: a) health education activities to strengthen habits of hygiene, and b) immunisation of susceptible individuals. A total of 646 people were vaccinated, with the active help of staff from the Institute of Rehousing and Integration into Society. RESULTS: The outbreak affected 26 people, with an average age of 8 (95% CI, 6.2-9.8), similar distribution by sex and 3.3% attack rate. Fourteen cases were students at state schools, not all in the same classes. There were 7 pairs of siblings among the cases. The diagnosis was conformed by serology in 17 cases. Five needed hospital admission. CONCLUSIONS: The epidemic curve suggested person-person transmission. All those affected were under 20 years old. Vaccination was seen to be effective in controlling the outbreak. Interventions were assisted by intermediaries in order to respect the gypsies' cultural context and were well accepted.

Brote comunitario de hepatitis A en un poblado marginal. Vacunación para su control y aceptación de la medida / Community outbreak of hepatitis A in a marginal population. Vaccination for its control and acceptance of the measure

Objetivo. Estudio de un brote comunitario de hepatitis A en un poblado marginal y respuesta de salud pública para su control. Diseño. Estudio descriptivo del brote ocurrido entre febrero y junio de 2004. Se realizó una encuesta epidemiológica para detectar casos previos y se instauró una vigilancia activa. Se establecieron las definiciones de caso y de paciente susceptible. Emplazamiento. Poblado de etnia gitana en Madrid. Dispone de dotaciones básicas de saneamiento sanitario, abastecimiento de agua y eliminación de residuos. Participantes. Población censada, 550 personas; población estimada, 800 personas. El 70% es menor de 40 años y el 55% es analfabeto. Intervenciones. Las medidas de control fueron: a) actividades de educación sanitaria para reforzar los hábitos higiénicos, y b) inmunización de las personas susceptibles. Se vacunó a un total de 646 personas, con la colaboración activa del personal del Instituto de Realojo e Inserción Social. Resultados. El brote ha afectado a 26 personas, con una media de edad de 8 años (intervalo de confianza del 95%, 6,2-9,8), similar distribución según el sexo y con una tasa ataque del 3,3%. Catorce casos son alumnos de colegios públicos, sin agregación por aulas. Entre los casos había 7 parejas de hermanos. El diagnóstico se confirmó por serología en 17 casos. Cinco necesitaron hospitalización. Conclusiones. La curva epidémica señala una transmisión persona-persona. Todos los enfermos son menores de 20 años. La vacunación ha mostrado ser una medida eficaz en el control del brote. Las intervenciones se realizaron con la colaboración de mediadores para respetar su contexto cultural y fueron bien aceptadas

Objective. To study a community outbreak of hepatitis A in a marginal population and the public health response in order to bring it under control. Design. Descriptive study of the outbreak that occurred in February-June, 2004. An epidemiological survey was conducted to detect prior cases and active vigilance was set up. Case and susceptibility definitions were established. Setting. A gypsy population in Madrid, Spain. They had basic provision of sewerage, water supply and waste disposal. Participants. A population of 550 in census; estimated population, 800. 70% were under 40 and 55% were illiterate. Interventions. Control measures were: a) health education activities to strengthen habits of hygiene, and b) immunisation of susceptible individuals. A total of 646 people were vaccinated, with the active help of staff from the Institute of Rehousing and Integration into Society. Results. The outbreak affected 26 people, with an average age of 8 (95% CI, 6.2-9.8), similar distribution by sex and 3.3% attack rate. Fourteen cases were students at state schools, not all in the same classes. There were 7 pairs of siblings among the cases. The diagnosis was conformed by serology in 17 cases. Five needed hospital admission. Conclusions. The epidemic curve suggested person-person transmission. All those affected were under 20 years old. Vaccination was seen to be effective in controlling the outbreak. Interventions were assisted by intermediaries in order to respect the gypsies' cultural context and were well accepted

[Development of an acute myocardial infarction risk adjustment model for Spain: comparison to the Charlson model and the ICES model. Application for gauging care results]. / Desarrollo de un modelo de ajuste por el riesgo para el infarto agudo de miocardio en españa: comparación con el modelo de Charlson y el modelo ICES. Aplicaciones para medir resultados asistenciales.

BACKGROUND: Acute myocardial infarction has a major bearing on morbimortality in developed countries. This study is aimed at developing a risk adjustment model for assessing the results of managing this disease and comparing how this management is carried out with other models. METHODS: A risk adjustment model is developed for acute myocardial infarction by means of logistic regression with the information from an administrative database including various Spanish hospitals, taking the intrahospital mortality rate as the response variable and variables inherent to the patient proper as predictive variables. The predictability thereof is compared to the Charlson Model and the ICES model. These models are applied for assessing the intrahospital mortality rate. RESULTS: The age (OR: 1.07), the anterolateral location (OR: 2.32) and inferoposterior location (OR: 1.91), cardiogenic shock (OR: 39.99), arrhythmia (OR: 94.43), cerebrovascular disease (OR: 2.15) and kidney failure (OR: 1.87) are shown to be related to a higher risk of death. The model developed provides a better predictability (-2LL: 2240) than the Charlson model (-2LL: 3073) and the ICES model (-2LL: 2366). There are no significant differences in the risk-adjusted death rate for the 23 hospitals studied, nor any differences between public and private hospitals nor the care volume or technological level. Coronariography (RMAR: 0.66) and percutaneous coronary interventions (RMAR: 0.69) are procedures having a protective effect. CONCLUSIONS: The model developed may be a useful tool for assessing the hospital care provided for myocardial infarction.

Desarrollo de un modelo de ajuste por el riesgo para el infarto agudo de miocardio en España: comparación con el modelo de Charlson y el modelo Ices. Aplicaciones para medir resultados asistenciales / Development of an acute myocardial infarction risk adjustment model for Spain: comparison to the Charlson model and the Ices model. Application for gauging care results

Fundamento: El infarto agudo de miocardio representa unaimportante carga de morbimortalidad en los países desarrollados. Elobjetivo de este trabajo es desarrollar un modelo de ajuste por el riesgopara evaluar los resultados del manejo de esta patología y compararsu desempeño con otros modelos.Métodos: Se desarrolla un modelo de ajuste de riesgo para elinfarto agudo de miocardio mediante regresión logística con la informaciónde una base de datos administrativa de hospitales españoles,considerando la mortalidad intrahospitalaria como variable respuestay variables propias del paciente como predictoras. Se compara sucapacidad predictiva con la del modelo de Charlson y el modelo ICES.Los modelos se aplican para evaluar la mortalidad intrahospitalaria.Resultados: La edad (OR: 1,07); la localización anterolateral(OR: 2,32) e inferoposterior (OR:1,91); el shock cardiogénico(OR:39,99), las arritmias (OR: 94,43), la enfermedad cerebrovascular(OR:2,15) y la insuficiencia renal (OR:1,87) aparecen asociadoscon un mayor riesgo de mortalidad. El modelo desarrollado ofrecemejor capacidad predictiva (-2LL: 2240) que el modelo de Charlson(-2LL: 3073) y el modelo ICES (-2LL: 2366). No hay diferenciassignificativas en la mortalidad ajustada por el riesgo de los 23 hospitalesestudiados, ni diferencias entre centros públicos y privados, nipor volumen de atención o nivel tecnológico. La coronariografía(RMAR: 0,66) y las intervenciones coronarias percutáneas (RMAR:0,69) son procedimientos con efecto protector.Conclusiones: El modelo desarrollado puede constituir unaherramienta útil para evaluar la práctica asistencial del infarto encentros hospitalarios(AU)

Background: Acute myocardial infarction has a major bearingon morbimortality in developed countries. This study is aimed atdeveloping a risk adjustment model for assessing the results ofmanaging this disease and comparing how this management iscarried out with other models.Methods: A risk adjustment model is developed for acute myocardialinfarction by means of logistic regression with the informationfrom an administrative database including various Spanish hospitals,taking the intrahospital mortality rate as the response variableand variables inherent to the patient proper as predictive variables.The predictability thereof is compared to the Charlson Model and theICES model. These models are applied for assessing the intrahospitalmortality rate.Results: The age (OR: 1.07), the anterolateral location (OR:2.32) and inferoposterior location (OR:1.91), cardiogenic shock(OR:39.99), arrhythmia (OR: 94.43), cerebrovascular disease(OR:2.15) and kidney failure (OR:1.87) are shown to be related to ahigher risk of death. The model developed provides a better predictability(-2LL: 2240) than the Charlson model (-2LL: 3073) and theICES model (-2LL: 2366). There are no significant differences in therisk-adjusted death rate for the 23 hospitals studied, nor any differencesbetween public and private hospitals nor the care volume ortechnological level. Coronariography (RMAR: 0.66) and percutaneouscoronary interventions (RMAR: 0.69) are procedures having aprotective effect.Conclusions: The model developed may be a useful tool forassessing the hospital care provided for myocardial infarction(AU)

[Tuberculosis and immigration in a health sanitary area in Madrid, Spain. Trends in 1994-2003]. / Tuberculosis e inmigración en un área sanitaria de Madrid. Situación epidemiológica y evolución en la década 1994-2003.

BACKGROUND AND OBJECTIVE: To describe trends and epidemiological characteristics of immigrant and native populations with tuberculosis. POPULATION AND METHOD: Population-based, descriptive analysis of case data reported to the Regional Registry of Tuberculosis Cases from 1994 to 2003 living in the south of Madrid, Spain (755,202 inhabitants). RESULTS: The number of cases reported was 2211, of which 269 (12.1%) were foreign-born persons. Tuberculosis incidence declined from 46.6/100,000 in 1994 (2.9% immigrants) to 25.2/100,000 in 2003 (35.8% immigrants) (p < 0.001). Foreign-born persons with tuberculosis had come to Spain from Latin America-Caribbean (56%), Africa (30%) and Europe (11%). Of the foreign-born, 73.6% developed active tuberculosis within 5 years of arrival (50.9% within 2 years). CONCLUSIONS: The incidence of tuberculosis has declined in the study area but the tendency to decrease has come to a halt because of cases occurring among immigrants. Among those for whom the date of Spain entry was known, a half arrived 2 years or less prior to the diagnosis of tuberculosis. We stress that tuberculosis control programs must target such at-risk population.

Tuberculosis e inmigración en un área sanitaria de Madrid. Situación epidemiológica y evolución en la década 1994-2003 / Tuberculosis and immigration in a health sanitary area in Madrid, Spain. Trends in 1994-2003

Fundamento y objetivo: El objetivo de este estudio es cuantificar el aumento de tuberculosis importada y comparar las características clinicoepidemiológicas entre inmigrantes y autóctonos. Población y método: Estudio descriptivo poblacional de casos diagnosticados en Madrid (Área 11, 755.202 habitantes), en el período 1994-2003. La fuente de datos utilizada fue el Registro Regional de Casos de Tuberculosis. Resultados: Se notificaron 2.211 casos, 269 (12,1%) correspondían a inmigrantes. La tasa de incidencia pasó de 46,6/100.000 en 1994 (2,9% inmigrantes) a 25,2/100.000 en 2003 (35,8% inmigrantes) (p < 0,001). Los inmigrantes procedían de América Latina-Caribe (56%), África (30%) y Europa (11%). El 73,6% desarrolló tuberculosis en el primer quinquenio de estancia (un 50,9% en el primer bienio). Conclusiones: Se evidencia una tendencia decreciente en la incidencia global de tuberculosis, con disminución en la población autóctona y aumento en la población inmigrante. La mitad de los pacientes inmigrantes enferman en los 2 primeros años

Background and objective: To describe trends and epidemiological characteristics of immigrant and native populations with tuberculosis. Population and method: Population-based, descriptive analysis of case data reported to the Regional Registry of Tuberculosis Cases from 1994 to 2003 living in the south of Madrid, Spain (755,202 inhabitants). Results: The number of cases reported was 2211, of which 269 (12.1%) were foreign-born persons. Tuberculosis incidence declined from 46.6/100,000 in 1994 (2.9% immigrants) to 25.2/100,000 in 2003 (35.8% immigrants) (p < 0,001). Foreign-born persons with tuberculosis had come to Spain from Latin America-Caribbean (56%), Africa (30%) and Europe (11%). Of the foreign-born, 73.6% developed active tuberculosis within 5 years of arrival (50.9% within 2 years). Conclusions: The incidence of tuberculosis has declined in the study area but the tendency to decrease has come to a halt because of cases occurring among immigrants. Among those for whom the date of Spain entry was known, a half arrived 2 years or less prior to the diagnosis of tuberculosis. We stress that tuberculosis control programs must target such at-risk population

[Patterns of tuberculosis transmission in a health area of Madrid]. / Patrones de transmisión de la tuberculosis en un área sanitaria de Madrid.

BACKGROUND: Employing molecular epidemiology techniques for the study of tuberculosis can afford the possibility of identifying tuberculosis transmission patterns. This study has been made for the purpose of estimating the incidence of tuberculosis related to recent transmission in Madrid and of identifying the risk factors making it possible to define transmission patterns. METHODS: A three-year descriptive populational study was conducted on patients diagnosed with tuberculosis based on cultures in four districts in Madrid (550,442 inhabitants). The transmission patterns were described by means of conventional epidemiological research and molecular techniques (Restriction Fragment Length Polymorphism--RFLP--analysis with IS6110 and spoligotyping). RESULTS: An RFLP analysis was conducted on 233 clinically isolated Mycobacterium tuberculosis strains, 99 (42.5%) of which were grouped into 29 clusters. The most numerous group was comprised of 134 patients infected with M. tuberculosis strains of a single RFLP pattern. These patients averaged 48.3 years of age (DE 19.4), and 17.2% were revealed to have an endogenous risk factor. Two transmission patterns were identified among the grouped cases. The first pattern included 57 patients pertaining to 23 small clusters (2-4 cases), 25 (43.9%) of which were epidemiologically linked to another case from the same cluster. The second pattern was comprised of 42 patients grouped into 6 large clusters (5 cases or more). The subjects averaged 31.4 years of age (DE 15.8), 28.6% being intravenous drug users, 31% infected with HIV, and 26.2% having a prison background. CONCLUSIONS: Identifying tuberculosis transmission patterns by using molecular biology techniques affords the possibility of detecting population groups for whom preferential measures can be taken in the prevention and control programs.

Patrones de transmisión de la tuberculosis en un área sanitaria de Madrid / Patterns of tuberculosis transmission in a health area in Madrid, Spain

Fundamento: La aplicación de las técnicas de epidemiología molecular en el estudio de la tuberculosis puede permitir identificar los patrones de transmisión de la enfermedad. El objetivo de este estudio ha sido estimar la incidencia de tuberculosis asociada a transmisión reciente en Madrid e identificar los factores de riesgo que permitan definir patrones de transmisión. Métodos: Se realizó un estudio descriptivo poblacional de tres años de duración en pacientes diagnosticados de tuberculosis mediante cultivo en cuatro distritos de Madrid (550.442 habitantes).La descripción de los patrones de transmisión se realizó mediante la investigación epidemiológica convencional y las técnicas moleculares (análisis de fragmentos de restricción de longitud polimórfica -RFLP- con IS6110 y spoligotyping). Resultados: Se realizó RFLP en 233 aislados clínicos de Mycobacterium tuberculosis, de los que 99 (42,5 por ciento) estaban agrupados en 29 clusters. El grupo más numeroso lo formaban 134 enfermos infectados por cepas de M. tuberculosis con patrón RFLP único. Su media de edad era 48,3 años (DE 19,4) y el 17,2 por ciento presentaba un factor de riesgo de reactivación endógena. Entre los casos agrupados se identificaron dos patrones de transmisión. El primero de ellos incluía a 57 enfermos pertenecientes a 23 clusters pequeños (2-4 casos), de los que 25 (43,9 por ciento) estaban conectados epidemiológicamente con otro caso de su mismo cluster. El segundo lo formaban 42 pacientes agrupados en 6 clusters grandes (5 casos o más). La media de edad era de 31,4 años (DE 15,8), el 28,6 por ciento eran usuarios de drogas inyectadas, el 31 por ciento estaban infectados por el VIH, y el 26,2 por ciento tenían antecedentes de estancia en prisión. Conclusiones: La identificación de patrones de transmisión de la tuberculosis utilizando técnicas de biología molecular permite detectar grupos de población susceptibles de actuación preferente en los programas de prevención y control (AU)