Risk factors for disease severity among hospitalised patients with 2009 pandemic influenza A (H1N1) in Spain, April - December 2009.

We describe the clinical and epidemiological characteristics of patients hospitalised with confirmed 2009 pandemic influenza A(H1N1) in Spain from April to December 2009 and the risk factors associated with a worse outcome (admission to an intensive care unit or death) in adults. Case-based epidemiological information was collected as part of the national strategy for the surveillance of severe cases. Of 3,025 patients, 852 were admitted to an intensive care unit and overall, 200 died. The median patient age was 38 years (range: 0­94). A total of 662 (26%) patients had no underlying risk conditions. Antiviral therapy was initiated within 48 hours after symptom onset in only 35.2% (n=711); the median length of time before treatment was four days. In a multivariate analysis, the start of antiviral therapy more than 48 hours after symptom onset (odds ratio (OR) 2.39; 95% confidence interval (CI): 1.79 to 3.2), morbid obesity (OR: 2.01; 95% CI 1.38 to 2.94), cardiovascular disease (OR: 1.79; 95% CI: 1.2 to 2.67) and chronic obstructive pulmonary disease (OR: 1.51; 95% CI: 1.03 to 2.2) were significantly associated with a worse outcome in adults.

Prevención de las enfermedades infecciosas / Prevention of infectious diseases

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[Update on chickenpox]. / Actualización en varicela.

Primary infection by varicella-zoster virus causes chickenpox and herpes zoster. At 14 years of age, 91% of the population have already suffered the illness and after 30 years, more than 95% have done so. In 1999, the hospitalization rate was 2.4 per 1,000 chickenpox cases in those under 14 and 15.5 per 1,000 cases in those over 14. A total of 73% of deaths recorded during the period 1991-2000 were in the older than 14 year old group. Efficacy of varicella vaccine after a 7-8 years period is 87%; a milder case of chickenpox (breakthrough) can appear in vaccinated people 42 days after vaccination. The introduction of the vaccine may be proposed to stop or decrease virus circulation among the population or to decrease complications and mortality from chickenpox. According to the objective proposed, different strategies that imply risks and benefits should be conducted.

Actualización en varicela / Update on chickenpox

La infección primaria por el virus varicella-zoster produce la varicela y el herpes zoster. A los14 años el 91% y a partir de los 30 años más del 95% de la población ya ha padecido la enfermedad. En el año 1999 la tasa de hospitalización en menores de 14 años fue de 2,6 por 1.000 casos de varicela y de 15,5 por 1.000 en los mayores de 14 años. El 73% de las muertes registradas durante el período 1991-2000 se han producido en mayores de 14 años. La eficacia de la vacuna antivaricela tras un período de 7-8 años es del 87%, en vacunados puede aparecer una varicela más leve, breakthrough, a los 42 días de la vacunación. La introducción de la vacuna puede plantearse para interrumpir o disminuir la circulación del virus en la población o para disminuir las complicaciones y la mortalidad. Según el objetivo planteado se deberían seguir distintas estrategias que implicaran beneficios y riesgos

Primary infection by varicella-zoster virus causes chickenpox and herpes zoster. At 14 years of age, 91% of the population have already suffered the illness and after 30 years, more than 95% have done so. In 1999, the hospitalization rate was 2.4 per 1,000 chickenpox cases in those under 14 and 15.5 per 1,000 cases in those over 14. A total of 73% of deaths recorded during the period 1991-2000 were in the older than 14 year old group. Efficacy of varicella vaccine after a 7-8 years period is 87%; a milder case of chickenpox (breakthrough) can appear in vaccinated people 42 days after vaccination. The introduction of the vaccine may be proposed to stop or decrease virus circulation among the population or to decrease complications and mortality from chickenpox. According to the objective proposed, different strategies that imply risks and benefits should be conducted

Impacto de los programas de vacunación en España / Impact of vaccination programmes in Spain

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Calendario de vacunación infantil y recomendaciones de vacunación en adultos / Childhood immunization schedule and recommended immunizations for adults

En el calendario de vacunación infantil, aprobado por el Consejo Interterritorial del Sistema Nacional de Salud para el año 2004, se incluye las vacunas recomendadas en el momento actual y su pauta de administración. Este nuevo calendario recoge un importante cambio en la historia de los programas de vacunación en nuestro país, la sustitución de la vacuna con virus vivos atenuados de la poliomielitis por vacuna con virus inactivados. Asimismo, el artículo revisa las recomendaciones actuales de vacunación en población adulta, recomendaciones que tienen como objetivo fundamental complementar los programas de vacunación infantil y reforzar su impacto en el control de la infección

The childhood immunization schedule, approved by the “Consejo Interterritorial del Sistema Nacional de Salud” for 2004, includes vaccines actually recommended and the guidelines for their administration. This new scheduie conteins an important change in the history of the immunization programs in our country, the use of inactivated polio vaccine (IPV) instead of oral polio vaccine (OPV). The article also reviews the recommended immunizations for adults, whose main targets are to complement the childhood immunization program and to reinforce its impact on disease control

La vacuna inactivada de la polio / Inactivated polio vaccine

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[Cytomegalovirus seroepidemiology in the community of Madrid]. / Seroepidemiología frente a citomegalovirus en la Comunidad de Madrid.

BACKGROUND: Cytomegalovirus (CMV) is frequently asymptomatic. However, it constitutes an important cause of congenital disease and severe pathology in immunodepressed patients, thus representing an important problem in Public Health. The object of this work was to study the prevalence of IgG against CMV (IgG-CMV) in the general population from Madrid. METHODS: It is a transversal study, in which IgG-CMV was assayed in a representative sample of the general population from the Region of Madrid, aged 2 to 60 years (n = 2030). Participants were recruited by a two-stage cluster sample procedure from those attending primary health care centres between October, 1993 and February, 1994. For the statistical analysis the chi 2 and chi 2 lineal trend tests were employed. The percentages of seroprevalence and the specific odds ratios were calculated with confidence intervals of 95%. RESULTS: The overall seroprevalence has been 62.8% (IC95% 60.6-64.9), ranging from 58.4% (IC95% 55.2-61.5) in men to 66.7% (IC95% 63.7-69.5) in women. A significant association between increase of the age and increment of the seroprevalence was observed. The consult to dentistry, the antecedent of surgery, as well as tattooing and acupuncture has been identified as risk factors of acquiring the infection. On the other hand, to have carried out University studies seems to act as a significant factor of protection. CONCLUSIONS: Although the risk factors detected indicates a transmission by blood, the high prevalence suggests the existence of other more common ways. The age-dependent seroprevalence increase confirms an important number of infections in the adult age. However, it cannot be exclude that this increase responds to an effect cohort due to socio-economic improvements similar to the detected for other virus.

[The effect of anti-measles control measures in health care within autonomous community of Madrid]. / Impacto de las medidas de control del sarampión por áreas sanitarias en la comunidad autónoma de Madrid.

BACKGROUND: Measles is a disease subject to a child vaceination programme that has undergone changes with respect to the epidemiological model employed. The purpose of this study is to define the temporal series of measles cases within the Autonomous Community of Madrid as of 1971 in each particular Medical Care Area, identify the risk of contracting the disease in each such area and to evaluate the effect of control measures against outbreaks of the disease. METHOD: A descriptive analysis is carried out of the temporal series relating to measles. Series components are obtained by means of a multiplication model: seasonal, cyclic or irregular trend. The break in transmission of the disease and risk attributed to each area is then compared. RESULTS: The number of reported cases of the disease decreased by 89% after implementation of the vaccination programme: the series has remained stable and it was observed that non-epidemie intervals have increased. The risk of contracting measles is greater in four Medical Care Areas and the transmission cycle has been broken in 6 Areas. CONCLUSIONS: Epidemiological behaviour of measles within the Autonomous Community of Madrid does not differ from other countries before and after the implementation of vaccination programmes. Evidence of the effects of control measures are evidenced by the decrease in the number of reported cases of the disease, change in the epidemiological pattern and break in transmission detected mainly in the Areas in which such controls have been carried out.

[Measures of the effect of vaccination in an outbreak of measles]. / Medidas del efecto de la vacunación en un brote de sarampión.

Vaccine efficacy, the effectiveness of a vaccination programme and the fraction of a population that would be necessary to vaccinate in order to prevent a measles outbreak are studied in a population having a vaccination programme. A dynamic model for acute, directly transmitted diseases was applied, based on the rate of transmission, namely, the probability that the infectious agent is transmitted from an infected to a susceptible person within a short space of time. We carried out a population-based study where we observed the final attack rates among vaccinated and unvaccinated people for a measles outbreak. In this population, the vaccination programme is responsible for a reduction of: 82.41% of all cases in the non-vaccinated sector; 98.45% of the average risk of disease among the vaccinated; and 97.29% of all cases among the population as a whole. Under these conditions there is the possibility of disease outbreaks arising, outbreaks which could be prevented if the percentage of the vaccinated population exceeded 95%.