Models of human psoriasis: Zebrafish the newly appointed player.

Psoriasis is a human chronic, immune disease with severe cutaneous and systemic manifestations. Its prevalence, among the world population, highly varies with ethnicity and geography, but not sex from remarkable low levels in Asia to 2.3% in Spain, or an impressive 11.5% in Norway. The pathogenesis of psoriasis derives from complex genetic and environmental interactions, which creates aberrant crosstalk between keratinocytes and variated immune cell, resulting in open amplified inflammatory and pro-proliferative circuits. Both, innate and adaptive immune systems are known to be involved in the response at the cellular and humoral levels. Nevertheless, the exact molecular mechanisms are still under debate. Therefore, discovering useful therapeutic targets to stretch the molecular gaps in psoriasis pathogenesis and its associated comorbidities is still mandatory. So far, some mutagenic or pharmacological studies in vitro or using comparative vertebrate models have provided critical molecular insights and directed the human research. Although highly feasible in rodents, the versatile physiology, genetic similarity to humans and outstanding molecular toolbox available, suggest that elaborate forward genetic screenings are far easier to be conducted using the zebrafish model. Thus, in this review, we intend to briefly overview psoriasis and revise in a digested fashion the preclinical research models available, emphasizing the zebrafish as a powerful tool in the study of immune effectors on the same, and how it supports the discovering of new therapies that may help in controlling this widespread disease around the globe.

Late detection of a shigellosis outbreak in a school in Madrid.

Even though shigellosis in Spain is rare, an indigenous outbreak is occasionally detected. We describe an outbreak in a school in Madrid caused by person-to-person transmission of Shigella sonnei. After the detection of Shigella sonnei in a stool sample from a 3 year old girl, an investigation at her school was initiated. Questionnaires were distributed to the parents of 520 pupils attending the school. A case was defined as a school case if it was the first case in a child's household, and as a household case if other members of the household had fallen ill first. We identified 88 cases (60 pupils and 28 of their family members). The attack rate (AR) was 12% in the school and 32% in the families. There was a significant association between higher AR and lower age. The outbreak lasted for two months. The length and the shape of the epidemic curve of the 60 cases in pupils suggests person-to-person transmission. Shigella sonnei isolated from 5 different cases were typed by pulsed field gel electrophoresis (PFGE) and was found to be an identical strain. The prolonged duration of the outbreak was probably due to delayed detection, and stopped as soon as control measures were introduced.

An outbreak of Campylobacter jejuni enteritis in a school of Madrid, Spain.

An outbreak of gastroenteritis caused by Campylobacter infection was identified in May 2003 in a school in Madrid, Spain. Eighty one cases were identified in a total of 253 people studied. A retrospective cohort study showed that a custard made with ultra high temperature (UHT) milk was associated with illness (RR: 3.15; 95% CI: 1.25-7.93). The custard was probably contaminated with Campylobacter jejuni from a raw chicken prepared a day previously in the same kitchen. Our recommendations were to periodically remind the school s authorities how to act if an outbreak should be suspected, to include the monitoring of a food handler s working day in each environmental investigation in order to detect any risk behaviour; to implement microbiological analysis from the surfaces and utensils of the collective kitchens and improve the sanitary education of food handlers.

[Chickenpox outbreak in Herrera del Duque, Badajoz, Spain]. / Brote de varicela en Herrera del Duque (Badajoz).

INTRODUCTION: Chickenpox is a worldwide disease with high morbidity but few complications, although complications can be sevre in immunocompromised individuals and healthy adults. The annual chickenpox rate declared to the National Notification Disease Surveillance System is approximately 5 cases per 1,000 inhabitants in Extremadura (Spain). The aim of this study was to identify and describe the characteristics and cost of an epidemic outbreak of chickenpox in Extremadura. METHODS: Between November 2000 and March 2001, a descriptive study was performed. Cases of chickenpox were actively sought in a cohort of schoolchildren in Herrera del Duque (Badajoz). The protocols of the Monitoring Network of the Autonomous Community of Extremadura was used for case definition. Microbiological confirmation was performed by isolation of the virus and the presence of IgM and IgG markers in serum. We analyzed the direct and indirect tangible costs as well as the intangible costs of the outbreak. RESULTS: Seventy-five cases were identified, of which 94.7% occurred in children aged between 1-9 years, mainly boys. The attack rate was 18.5 cases per 1,000 inhabitants and 68.2% occurred in children aged less than 10 years charing a home. The clinical course was benign, without hospital admissions or complications. A total of 71.6% of children aged between 3 and 8 years were susceptible. A possible temporary aggregation of cases in the school was analyzed and a relative risk of 5.01 (p < 0.0001) was obtained. The virus was isolated in the 4 vesicle samples studied and serology was positive (IgM) in the 9 serum samples studied. The total cost of the outbreak was of 927,21 e, with a mean of 12,53 e per case and 205 school days lost. CONCLUSION: A chickenpox outbreack was confirmed in Herrera del Duque, with person-to-person transmission, affecting children aged between 1 and 9 years. The high susceptibility of the pupils, the characteristics of teaching, and the meetings prior to the carnivals played a determining role in the transmission of the epidemic. The estimated cost of this outbreak was 76% less than the cost that would have been generated by single-dose vaccination of the 75 individuals who contracted the disease.

Brote de varicela en Herrera del Duque (Badajoz) / Chickenpox outbreak in Herrera del Duque, Badajoz, Spain

Introducción: La varicela es una enfermedad de distribución mundial con una elevada morbilidad y pocas complicaciones, aunque puede presentar cuadros clínicos graves en inmunodeprimidos y adultos sanos. El objeto de este estudio es identificar y describir las características y los costes de un brote epidémico en Extremadura, cuya tasa anual de casos declarados al sistema de Enfermedades de Declaración Obligatoria (EDO) oscila en alrededor de 5 por 1.000 habitantes. Métodos: Estudio descriptivo con búsqueda activa de casos entre los meses de noviembre del año 2000 y marzo de 2001, y de la susceptibilidad de la cohorte escolarizada del colegio de Herrera del Duque (Badajoz). Las definiciones de casos fueron recogidas de los protocolos de la Red de Vigilancia de la comunidad extremeña. La confirmación microbiológica se realizó por aislamiento del virus y por presencia de marcadores IgM e IgG en el suero del enfermo. Se analizaron los costes tangibles directos e indirectos y los no tangibles del brote. Resultados: De los 75 casos identificados, 71 (94,7 por ciento) eran niños de entre uno y 9 años, predominando el sexo masculino. La tasa de ataque fue de 18,5 casos por 1.000 habitantes, y del 68,2 por ciento en convivientes menores de 10 años. La evolución fue benigna, sin ingresos hospitalarios ni complicaciones. Se encontró un 71,6 por ciento de niños susceptibles en los de entre 3 y 8 años. Se analizó una posible agregación temporal de casos en el colegio, obteniéndose un riesgo relativo (RR) de 5,01 (p < 0,001). Se aisló el virus en las 4 muestras de vesículas estudiadas y la serología (IgM) fue positiva en los 9 sueros estudiados. El coste total de brote fue de 927,21 e, con una media de 12,53 e por caso, y 205 días de pérdida escolar. Conclusión: Se confirmó la existencia de un brote de varicela en el colegio de la localidad de Herrera del Duque, con transmisión persona a persona, que afectó a niños de entre uno y 9 años. La elevada susceptibilidad del alumnado, las características de la docencia y las reuniones previas a los carnavales tuvieron un papel determinante en la propagación de la epidemia. El coste estimado para este brote se corresponde con un gasto un 76 por ciento menor del producido por la vacunación con una dosis de los 75 casos de este brote (AU)

Exhaustividad de los registros de sida en España / Estimating the completeness of AIDS reporting in Spain

Objetivo: Valorar la notificación de casos de sida en las comunidades autónomas por comparación con las muertes por sida registradas en las estadísticas de defunciones, a fin de identificar posibles desviaciones indicativas de subnotificación. Métodos: Tomando como unidad de análisis la comunidad autónoma, se compararon las tasas de incidencia y mortalidad, según el Registro Nacional de Sida, con las de mortalidad por VIH y sida obtenidas de las estadísticas de defunciones del Instituto Nacional de Estadística. Se analizó globalmente el período 1986-1998, y se repitió el análisis para el período 1995-1998.Resultados: En el período 1986-1998 hubo una buena correlación (r = 0,93) entre las tasas de incidencia de sida y las de mortalidad por VIH/sida según las estadísticas de defunciones. Algunas comunidades presentaron una incidencia de sida menor que la esperada por su tasa de mortalidad en comparación con el promedio estatal, destacando Asturias (-27 por ciento), la Comunidad Valenciana (-26 por ciento), Andalucía (-20 por ciento), Ceuta (-18 por ciento) y Cantabria (-13 por ciento). Tomando como referencia las cinco comunidades con mayor exhaustividad, la subnotificación estimada para el conjunto de España fue del 13 por ciento. En el período 1995-1998 estas desviaciones han aumentado moderadamente. En el período 1986-1998 se notificaron un 18,9 por ciento menos de muertes al Registro Nacional de Sida que a la estadística de defunciones, con una gran variabilidad entre comunidades. Conclusiones: El nivel de notificación de sida en España es aceptable para los fines de la vigilancia epidemiológica, aunque en algunas comunidades deberían tomarse medidas para mejorarlo. La notificación de fallecimientos al registro de sida presenta grandes deficiencias (AU)

[Brucellosis as occupational disease: study of an outbreak of air-born transmission at a slaughter house]. / La brucelosis como enfermedad profesional: estudio de un brote de transmision aerea en un matadero.

BACKGROUND: The onset of a large number of cases of brucellosis among employees at a slaughterhouse in Zaragoza where sheep from livestock culling procedures were being slaughtered, led to an investigation being made for the purpose of shedding light on the cause of this outbreak. METHODS: This study was organized into three parts: 1) Description of the outbreak 2) Study of the slaughterhouse layout and activity as regards the number of animals slaughtered, the employee workload and the degree of risk involved in each working area and 3) Unmatched case-control study. RESULTS: No significant differences were found among the attack rates by the sections of the slaughterhouse where the employees in question worked. The slaughtering analysis revealed a concomitant fluctuation between the slaughter of culled sheep and the epidemic. The case-control study revealed no significant differences for the risk factors involving working in a risk area, the use of protective measures and cuts/wounds. CONCLUSIONS: This outbreak is related to the slaughter of culled sheep. The fact that no significant difference were found by sections or due to working in a risk area is compatible with an overall explanation. Nor were any differences among the employees found to exist with regard to cuts/wounds or the use of protective measures, which focuses importance on airborne spread.

Incidence of pulmonary tuberculosis and HIV coinfection in the province of Seville, Spain, 1998.

Using the National Notifiable Disease Surveillance System (NNDSS) and Minimum Basic Data Set (MBDS) for hospital discharges we evaluated pulmonary tuberculosis (PTB) surveillance and estimated real PTB incidence and human immunodeficiency virus (HIV) coinfection in Seville in 1998. In addition, we assessed the sensitivity and the positive predictive value (PPV) of the surveillance system. Real incidence of pulmonary tuberculosis was estimated by the capture-recapture method. In 1998, the province of Seville reported 225 cases of pulmonary tuberculosis to the NNDSS, an incidence of 13.2 per 100,000 population. Of the 225 cases reported, 18.2% presented with HIV coinfection, while a total of 194 had confirmed diagnoses. The MBDS accounted for 106 new cases. Of these, 24.8% presented with HIV coinfection and were 58% less likely to be reported to the NNDSS (25-76%, p = 0.001). Applying the capture-recapture method, 426 cases were estimated, an overall incidence of 25.6 per 100,000 population (21.5-28.8). Completeness for each source was similar (47%), and for both jointly was 72.7%. The NNDSS had a sensitivity of 65.3% and a PPV of 89.3%. In conclusion, the NNDSS underestimates PTB and PTB-HIV coinfection in Seville. The high incidence observed in young adults suggests a high degree of tuberculosis endemicity. Hospital records provide a readily accessible, low-cost means of estimating disease incidence.

[Comparative study of Salmonella and Campylobacter infections in Huesca. 1996-1999]. / Estudio comparado de infección por Salmonella y Campylobacter en Huesca. 1996-1999.

BACKGROUND: The Salmonella and Campylobacter genera are the main bacterial agents causing enteritis in humans in the developed countries. The purpose of this paper is to study the descriptive characteristics of the cases of infection by Salmonella and by Campylobacter and to describe their trend and seasonal variance in the province of Huesca for the 1996-1999 period. METHOD: The sources of information were the Hospital Microbiological Laboratories (HML's) which conduct coproculture analyses of both outpatients and inpatients. The municipality is taken as the reference unit for plotting the space distribution. For the study of the trend, a multiplicative determinist model is used for grouping the data into four-week periods. RESULTS: A total of 781 cases of infection by Salmonella and 654 cases of infection by Campylobacter have been included, respectively showing mean annual rates of 95 and 79.5 x 10(5) inhabitants. The enteritis by Campylobacter occurs mainly in children under five years of age (73.4%), as compared to the 35.5% of the cases of salmonellosis. The situation is the reverse in the case of the hospital admission percentages, hospitalization due to salmonellosis hence being nearly five times greater. Both of these genera are of a clear-cut seasonal nature, showing a marked peak in the month of August. CONCLUSIONS: A growing trend in the number of positive isolations for both of these organisms and a clear seasonality in the summertime have been found.

[Estimating the completeness of AIDS reporting in Spain]. / Exhaustividad de los registros de sida en España.

OBJECTIVE: To evaluate AIDS case reporting in the Spanish regions as compared with the AIDS deaths registered in mortality statistics, in order to identify possible deviations indicative of underreporting. METHODS: We carried out an ecological analysis taking each region as a unit. We compared incidence and mortality obtained from the AIDS reporting system with the HIV/AIDS deaths obtained from the mortality statistics of the Spanish Institute for Statistics. The 1986-1998 period was analysed globally, then the analysis was repeated for the 1995-1998 period. RESULTS: In the 1986-1998 period there was a good correlation (r = 0.93) between the AIDS incidence rates and HIV/AIDS mortality rates obtained from death statistics. Some regions presented an AIDS incidence lower than expected according to their mortality rate when it was compared with the national average, with Asturias (27%), Comunidad Valenciana (26%), Andalucia (20%), Ceuta (18%) and Cantabria (13%) standing out. Taking as a reference the five regions with the highest completeness, the underreporting in Spain was of 13%. In the 1995-1998 period these deviations increased moderately. In the 1986-1998 period, 18.9% less deaths were notified to the AIDS reporting system in comparison with death statistics, showing a great variability between regions. CONCLUSIONS: In Spain the reporting level of AIDS cases is acceptable for the aims of surveillance, although in some regions measures to improve it should be taken. The notification of deaths to the AIDS reporting system presents great deficiencies.

[Levels of bactericidal antibodies against meningococcus C after vaccination in 2- to 6-year-old children in Andalusia]. / Niveles de anticuerpos bactericidas frente a meningococo C tras la vacunación de niños de 2 a 6 años de edad en Andalucía.

BACKGROUND: In 1997, 18.5% of the cases of Meningococcal Disease caused b serogroup C in Andalusia were children between 2 and 4 years of age; ages where the initial immune response and the duration of the capsular A + C meningococcal polysaccharide vaccine is less than in older age groups. Research was designed in order to measure the immune response produced by this vaccine in children from 2 to 6 years of age and to compare it with the natural immunity present in unvaccinated children. METHODS: I. Dual monitoring study: a) groups of children vaccinated previously and control groups, b) groups of children who were going to be vaccinated, for pre and post-vaccination (1, 6 and 12 months) analysis and a control group. II. The bactericidal activity was measured according to the standardised protocol of the CDC with regard to the strain of N. meningitidis C-11. The sera with bactericidal activity (TAB) > 1:8 were considered to be protective. RESULTS: 1 and 2 months following vaccination, the proportion of TAB > 1:8 was significantly higher than that of the control group (65.6% and 73% in comparison to 2.2% and 12%). In the pre-vaccine and post-vaccine (after 6, 7, 12 and 13 months) verification, no significant difference between vaccinated individuals and controls was observed. CONCLUSIONS: The differences between vaccinated and unvaccinated individuals 1 and 2 months following vaccination indicate seroconversion in the vaccinated individuals. For the age group of between 2 to 6 years of age, the bactericidal activity acquired decline quickly, as, after 6 months, differences between this group and the control group are no longer observed.

[Outbreak of gastroenteritis at a home for the aged in Albacete]. / Brote de gastroenteritis en una residencia de ancianos de Albacete.

BACKGROUND: We describe the investigation of an acute gastroenteritis outbreak with an explosive beginning, probably waterborne, that occurred in an nursing home in Albacete, in November 1999 and affected 104 inmates and 35 employees. The dominant symptoms were diarrhea and vomiting. METHODS: A case-control study was designed. We carried out a descriptive analysis of facts and crossing of variables with the help of simple tables. A multivariant analysis, by models of logistic regression, was conducted both for the explosive phase and for that of transmission person-to-person. RESULTS: The attack rate for inmates was 45.8% and for employees, 33.7%. An association was found between the use of the main dining-room of the nursing home and the explosive beginning of the outbreak and between the previous presence of a case-patient in the shared bedrooms and the person-to-person transmission. Norwalk-like virus was isolated from faeces samples of four cases. CONCLUSIONS: The analysis of the clinical and epidemiological findings as well as the laboratory results proved the implication of a Norwalk-like virus in this outbreak.

[The evaluation of epidemiological services related to brucellosis in the Autonomous Community of the Basque Country]. / Evaluación de la vigilancia epidemiológica de la brucelosis en la Comunidad Autónoma del Pais Vasco.

BACKGROUND: Spain's Epidemiologic Notifiable Disease Surveillance System (ENDSS) was evaluated by reference to Brucellosis, the zoonoses with greatest incidence countrywide and a disease that is notifiable on a case by case basis in the Basque Autonomous Region (BAR). METHODS: ENDSS information and the use to which it was put, were analysed. Active case searching was carried out via the Microbiologic Information System (MIS), public hospitals and the Occupational Disease Registry (ODR). A comparison was run between reported and search data. The capture-recapture method was used to compare ENDSS against hospital cases. RESULTS: Risks and outbreaks wee detected. Suspect cases were not reported. There was a 40% post-search increase in cases, i.e., 40 versus a previous figure of 24. Sensitivity was estimated at 60%. Predictive Value Positive could not be computed however. No case definition was in force. As estimated by the capture-recapture method, overall sensitivity for both ENDSS and hospital-based surveillance was 84% (95% IC: 70-100). The number of cases estimated by this method was 38 +/- 8. CONCLUSIONS: Underreporting is in evidence and, as a consequence, sensitivity is low. A case definition is called for. Response time is slowed by awaiting confirmation before reporting. The number of cases detected through active searching is compatible with that calculated by the capture-recapture method using only two sources.

Interregional foodborne salmonellosis outbreak due to powdered infant formula contaminated with lactose-fermenting Salmonella virchow.

Spain's Salmonella surveillance system backed by regionally-based epidemiologists around the country made it possible to detect and halt the spread of a foodborne salmonellosis outbreak due to powdered infant formula contaminated with a lactose-fermenting strain of Salmonella virchow. Forty-eight cases involving children, mostly under 7 months old, were detected in 14 out of Spain's 17 Regions. The outbreak started in January and ended in June 1994. All cases were microbiologically confirmed. The implicated strain had a 3.6 kb plasmid, was susceptible to all antimicrobials tested except nitrofurantoin and was phagetype 4a. Isolates from 8 of 24 Brand "A" milk samples tested had the same characteristics as case isolates. All affected/suspect batches of Brand "A" milk were destroyed and the product withdrawn from sale, which led to the end of the outbreak. This incident underscores the importance of maintaining surveillance systems able to detect and prevent foodborne outbreaks and alert to the possibility of isolating unusual lactose-fermenting Salmonella serotypes in especially sensitive food products.

Trends in hepatitis A virus infection with reference to the process of urbanization in the greater Madrid area (Spain).

Hepatitis A is an infection transmitted by the fecal-oral route. Endemicity within a specific country is directly related to sanitation and hygienic standards, while being inversely related to socioeconomic conditions. We studied how the process of urbanization witnessed in Madrid had influenced the transmission of hepatitis A infection. In the Madrid Autonomous Region, this process first began in the early sixties and was not brought to a close until the late seventies. Catalytic models were used to estimate the annual infection rate, lambda, on the basis of seroprevalence data stratified by age. A cohort effect related to a fall-off in infancy-related hepatitis A virus (HAV) is to be observed in the results for the last few years. The model permits four birth cohort-based groups to be differentiated by lambda: individuals born pre-1960, lambda = 0.082 (95% CI 0.095-0.070); those born in the early sixties, lambda = 0.052 (95% CI 0.060-0.042); whose members were born in the late sixties, lambda = 0.033 (95% CI 0.041-0.025); and those born in the late seventies, lambda = 0.017 (95% CI 0.020-0.013). The first group includes those born before the urbanization process had started. The second and third groups coincide with the development stage of that process, hence exhibiting transitional rates. The fourth group reflects the process in its consolidation stage. This reduction in the transmission of infection has changed the manner of presentation, so that while isolated cases or small outbreaks tend to be more common nowadays, occasionally epidemics may evolve explosively. The average age at presentation has risen and the likelihood of symptomatic infection is higher.