Latitude and longitude as drivers of COVID-19 waves' behavior in Europe: A time-space perspective of the pandemic.

BACKGROUND: Social restrictions and vaccination seem to have shaped the pandemic development in Europe, but the influence of geographical position is still debated. This study aims to verify whether the pandemic spread through Europe following a particular direction, during the period between the start of the pandemic and November 2021. The existence of a spatial gradient for epidemic intensity is also hypothesized. METHODS: Daily COVID-19 epidemiological data were extracted from Our World in Data COVID-19 database, which also included vaccination and non-pharmacological interventions data. Latitude and longitude of each country's centroid were used as geographic variables. Epidemic periods were delimited from epidemic surge data. Multivariable linear and Cox's regression models were performed for each epidemic period to test if geographical variables influenced surge dates. Generalized additive models (GAM) were used to test the spatial gradient hypothesis with three epidemic intensity measures. RESULTS: Linear models suggest a possible west-east shift in the first epidemic period and features a significant association of NPIs with epidemic surge delay. Neither latitude nor longitude had significant associations with epidemic surge timing in both second and third periods. Latitude displays strong negative associations with all epidemic intensity measures in GAM models. Vaccination was also negatively associated with intensity. CONCLUSIONS: A longitudinal spread of the pandemic in Europe seems plausible, particularly concerning the first wave. However, a recurrent trend was not observed. Southern Europe countries may have experienced increased transmissibility and incidence, despite climatic conditions apparently unfavourable to the virus.

Análisis espacial y temporal de la enfermedad neumocócica invasora por serotipos resistentes a eritromicina / Spatial and temporal analysis of invasive pneumococcal disease due to erythromycinresistant serotypes

Objetivos: Estudiar la distribución espacio-temporal de los casos de enfermedad neumocócica invasora (ENI) por serotipos resistentes a eritromicina y su relación con el consumo comunitario de macrólidos y la cobertura vacunal infantil. Métodos: Se seleccionaron los casos de ENI en mayores de 59 años residentes en la Comunidad de Madrid (CM) notificados en el periodo de 2007 a 2016. Las variables estudiadas fueron obtenidas de los sistemas de información vacunal y de Prestación Farmacéutica. Se utilizó el punto de corte (concentración mínima inhibitoria de eritromicina > 0,5 mg/L) de la clasificación de EUCAST para definir los serotipos resistentes a eritromicina. Mediante JointPoint se estimaron las tendencias de las incidencias de casos por serotipos resistentes a eritromicina incluidos en la vacuna trecevalente (STVCN13) y no incluidos (STnoVCN13). La asociación de esas incidencias con el consumo comunitario de macrólidos y la cobertura vacunal se hizo mediante modelos de Poisson. Para la detección de clústeres espacio-temporales se utilizó el estadístico Satscan. Resultados: Se identificaron 1.936 casos, de ellos, se detectó que 427 serotipos eran resistentes a la eritromicina. La incidencia de todos los casos por serotipos resistentes fue descendente (AAPC: -5,40%). La incidencia de casos por STVCN13 resistentes a la eritromicina fue descendente con un porcentaje anual del cambio (APC: -13,8) y estuvo asociada inversamente a la cobertura vacunal infantil (IRR 0,641), mientras que la de casos por STnoVCN13 resistentes a eritromicina fue ascendente (APC: 4,5) y no se asoció con la cobertura. Se detectó un clúster por STnoVCN13 y ninguno por STVCN13 tras la inclusión de la trecevalente en el calendario vacunal infantil. Conclusiones: El descenso de ENI por STVCN13 resistentes se asoció con el incremento de la cobertura vacunal infantil...(AU)

Objectives: To study the spatio-temporal distribution of cases of invasive pneumococcal disease (IPD) due to serotypes resistant to erythromycin and its relationship with community consumption of macrolides and childhood vaccination coverage. Methods: We selected IPD cases in adults over 59 years old, residents in the Community of Madrid (MC), notified in the period 2007-2016. The variables studied were obtained from the Vaccination Information Systems and the Pharmaceutical Service. The cut-off point (minimum inhibitory erythromycin concentration > 0.5 mg/L) of the EUCAST classification was used to define erythromycin resistant serotypes. We used JointPoint to estimate the incidence trends by erythromycin resistant serotypes included in the 13-valent vaccine (STPCV13) and not included in it (STnoPCV13). The association of these incidences with the community consumption of macrolides and vaccination coverage was made using Poisson models. Statistical scanning was used for the detection of temporal-spaces clusters of cases. Results: 1936 cases were identified, of which 427 erythromycin resistant serotypes were identified. The incidence of all cases due to resistant serotypes was decreasing (AAPC: -5,40%). During the period studied, the incidence of cases due to erythromycin resistant STPCV13 was decreasing with an annual percentage change (APC): -13.8 and was inversely associated with childhood vaccination coverage (IRR 0.641), while that of cases due to erythromycin resistant STnoPCV13 was ascending (APC): 4.5; and was not associated with coverage. 1 cluster was detected by STnoPCV13 and none by STPCV13 after the date of inclusion of the 13-valent in the childhood vaccination calendar. Conclusions: The decrease in IPD due to resistant STPCV13 was associated with an increase in childhood vaccination coverage...(AU)

Spatial and temporal analysis of invasive pneumococcal disease due to erythromycinresistant serotypes.

OBJECTIVES: To study the spatio-temporal distribution of cases of invasive pneumococcal disease (IPD) due to serotypes resistant to erythromycin and its relationship with community consumption of macrolides and childhood vaccination coverage. METHODS: We selected IPD cases in adults over 59 years old, residents in the Community of Madrid (MC), notified in the period 2007-2016. The variables studied were obtained from the Vaccination Information Systems and the Pharmaceutical Service. The cut-off point (minimum inhibitory erythromycin concentration > 0.5 mg/L) of the EUCAST classification was used to define erythromycin resistant serotypes. We used JointPoint to estimate the incidence trends by erythromycin resistant serotypes included in the 13-valent vaccine (STPCV13) and not included in it (STnoPCV13). The association of these incidences with the community consumption of macrolides and vaccination coverage was made using Poisson models. Statistical scanning was used for the detection of temporal-spaces clusters of cases. RESULTS: 1936 cases were identified, of which 427 erythromycin resistant serotypes were identified. The incidence of all cases due to resistant serotypes was decreasing (AAPC: -5,40%). During the period studied, the incidence of cases due to erythromycin resistant STPCV13 was decreasing with an annual percentage change (APC): -13.8 and was inversely associated with childhood vaccination coverage (IRR 0.641), while that of cases due to erythromycin resistant STnoPCV13 was ascending (APC): 4.5; and was not associated with coverage. 1 cluster was detected by STnoPCV13 and none by STPCV13 after the date of inclusion of the 13-valent in the childhood vaccination calendar. CONCLUSIONS: The decrease in IPD due to resistant STPCV13 was associated with an increase in childhood vaccination coverage. The presence of clusters due to STnoPCV13 after the date of inclusion of the 13-valent vaccine in the childhood vaccination calendar indicates serotypes replacement. The increase in cases of resistant STnoPCV13 could be related to the replacement of vaccine serotypes in nasopharyngeal colonization, facilitated by the consumption of macrolides still at high levels in MC.

Spatial and temporal analysis of invasive pneumococcal disease due to erythromycinresistant serotypes. / Análisis espacial y temporal de la enfermedad neumocócica invasora por serotipos resistentes a eritromicina.

OBJECTIVES: To study the spatio-temporal distribution of cases of invasive pneumococcal disease (IPD) due to serotypes resistant to erythromycin and its relationship with community consumption of macrolides and childhood vaccination coverage. METHODS: We selected IPD cases in adults over 59 years old, residents in the Community of Madrid (MC), notified in the period 2007-2016. The variables studied were obtained from the Vaccination Information Systems and the Pharmaceutical Service. The cut-off point (minimum inhibitory erythromycin concentration > 0.5 mg/L) of the EUCAST classification was used to define erythromycin resistant serotypes. We used JointPoint to estimate the incidence trends by erythromycin resistant serotypes included in the 13-valent vaccine (STPCV13) and not included in it (STnoPCV13). The association of these incidences with the community consumption of macrolides and vaccination coverage was made using Poisson models. Statistical scanning was used for the detection of temporal-spaces clusters of cases. RESULTS: 1936 cases were identified, of which 427 erythromycin resistant serotypes were identified. The incidence of all cases due to resistant serotypes was decreasing (AAPC: -5,40%). During the period studied, the incidence of cases due to erythromycin resistant STPCV13 was decreasing with an annual percentage change (APC): -13.8 and was inversely associated with childhood vaccination coverage (IRR 0.641), while that of cases due to erythromycin resistant STnoPCV13 was ascending (APC): 4.5; and was not associated with coverage. 1 cluster was detected by STnoPCV13 and none by STPCV13 after the date of inclusion of the 13-valent in the childhood vaccination calendar. CONCLUSIONS: The decrease in IPD due to resistant STPCV13 was associated with an increase in childhood vaccination coverage. The presence of clusters due to STnoPCV13 after the date of inclusion of the 13-valent vaccine in the childhood vaccination calendar indicates serotypes replacement. The increase in cases of resistant STnoPCV13 could be related to the replacement of vaccine serotypes in nasopharyngeal colonization, facilitated by the consumption of macrolides still at high levels in MC.

Geographic variations in cervical cancer risk in San Luis Potosí state, Mexico: A spatial statistical approach.

BACKGROUND: Worldwide, Cervical Cancer (CC) is the fourth most common type of cancer and cause of death in women. It is a significant public health problem, especially in low and middle-income/Gross Domestic Product (GDP) countries. In the past decade, several studies of CC have been published, that identify the main modifiable and non-modifiable CC risk factors for Mexican women. However, there are no studies that attempt to explain the residual spatial variation in CC incidence In Mexico, i.e. spatial variation that cannot be ascribed to known, spatially varying risk factors. METHODS: This paper uses a spatial statistical methodology that takes into account spatial variation in socio-economic factors and accessibility to health services, whilst allowing for residual, unexplained spatial variation in risk. To describe residual spatial variations in CC risk, we used generalised linear mixed models (GLMM) with both spatially structured and unstructured random effects, using a Bayesian approach to inference. RESULTS: The highest risk is concentrated in the southeast, where the Matlapa and Aquismón municipalities register excessive risk, with posterior probabilities greater than 0.8. The lack of coverage of Cervical Cancer-Screening Programme (CCSP) (RR 1.17, 95 % CI 1.12-1.22), Marginalisation Index (RR 1.05, 95 % CI 1.03-1.08), and lack of accessibility to health services (RR 1.01, 95 % CI 1.00-1.03) were significant covariates. CONCLUSIONS: There are substantial differences between municipalities, with high-risk areas mainly in low-resource areas lacking accessibility to health services for CC. Our results clearly indicate the presence of spatial patterns, and the relevance of the spatial analysis for public health intervention. Ignoring the spatial variability means to continue a public policy that does not tackle deficiencies in its national CCSP and to keep disadvantaging and disempowering Mexican women in regard to their health care.

Distribución espacial de la tuberculosis en España mediante métodos geoestadísticos / Space distribution of tuberculosis in Spain by geostatistical methods

Fundamentos: La incidencia de tuberculosis (TB) se haasociado a factores, epidemiológicos y sociales. En España, laTB es una enfermedad de declaración obligatoria e individualizada.Las tasas de TB respiratoria experimentan un descensoconstante en los últimos años. El objetivo es valorar la asociaciónentre la morbilidad por TB respiratoria y variables socioeconómicasy epidemiológicas así como su distribución espacialmediante métodos geoestadísticos.Método: Las tasas de incidencia se estandarizaron poredad y sexo con datos de la Red Nacional de Vigilancia (2006).Las variables socioeconómicas incluidas son: condiciónsocioeconómica, nivel de estudios, tasa de hacinamiento, densidadde población, tasa de inmigración estandarizada porsexo, tasa de analfabetismo, tasa de paro, gasto medio en eurospor persona. Las variables epidemiológicas incluidas han sidola tasa de SIDA y la tasa de incidencia de gripe. Se realizó unanálisis multivariable mediante un Modelo Lineal Generalizadopoisson. Se aplicó la técnica geoestadística Cokringingajustada por las variables estadísticamente significativas paraver la distribución espacial de riesgo.Resultados: Las variables estadísticamente significativasson la tasa de hacinamiento, tasa de inmigración, tasa de analfabetismo,tasa de paro, gasto medio euros por persona, tasa degripe y tasa de sida. La técnica geoestadística muestra unavariabilidad espacial del riesgo y una concentración del riesgoen el noroeste y sureste de la península.Conclusiones: Los resultados permiten afirmar que elmétodo Cokriging es una herramienta útil para representar ladistribución espacial del riesgo. Existe asociación entre variablessocioeconómicas , epidemiológicas y TB en España(AU)

Background: Tuberculosis incidence has been associatedwith many factors, both epidemiological and social. In Spain,tuberculosis is a statutorily notifiable disease requiringindividualised reporting. During the last few years rates ofrespiratory tuberculosis show a steady decline. This study soughtto assess respiratory tuberculosis morbidity and mortality inassociation to socio-economic and epidemiological covariatesand estimate its spatial distribution across the country, using geostatisticalmethods.Methods: Respiratory tuberculosis incidence rates werestandardised by age and sex with the data of the NationalEpidemiological Surveillance Network (RENAVE, RedNacional de Vigilancia Epidemiológica) for 2006. Thefollowing socio-economic variables were included in thestudy: socio-economic status, educational level, overcrowdingrate, population density, standardised immigration rate by sex,unemployment rate and average spending per person in euros.The epidemiological variables included were, such as, AIDSrate and the influenza incidence rate. To assess the associationof covariables a multivariate analysis was performed using aGeneralised Linear Model assuming Poisson distribution. Thegoestatistical method Co-kriging was adjusted with thesignificant variables to built the spatial distribution of risk.Results: The statistically significant covariates wereovercrowding rate, standardised immigration rate by sex,educational level, unemployment rate, average spending perperson in euros, AIDS rate and the influenza incidence rate. Thegeostatistical method shows spatial variability of the risk withhigher risks in the northwest and southeast of the peninsula.Conclusion: Results prove that the Co-kriging method is auseful tool to show the spatial distribution of risk. Alternatively,tuberculosis is associated with both social and epidemiologicalcovariates(AU)

[Space distribution of tuberculosis in Spain by geostatistical methods]. / Distribución espacial de la tuberculosis en España mediante métodos geoestadísticos.

BACKGROUND: Tuberculosis incidence has been associated with many factors, both epidemiological and social. In Spain, tuberculosis is a statutorily notifiable disease requiring individualised reporting. During the last few years rates of respiratory tuberculosis show a steady decline. This study sought to assess respiratory tuberculosis morbidity and mortality in association to socio-economic and epidemiological covariates and estimate its spatial distribution across the country, using geo-statistical methods. METHODS: Respiratory tuberculosis incidence rates were standardised by age and sex with the data of the National Epidemiological Surveillance Network (RENAVE, Red Nacional de Vigilancia Epidemiológica) for 2006. The following socio-economic variables were included in the study: socio-economic status, educational level, overcrowding rate, population density, standardised immigration rate by sex, unemployment rate and average spending per person in euros. The epidemiological variables included were, such as, AIDS rate and the influenza incidence rate. To assess the association of covariables a multivariate analysis was performed using a Generalised Linear Model assuming Poisson distribution. The goestatistical method co-kriging was adjusted with the significant variables to built the spatial distribution of risk. RESULTS: The statistically significant covariates were overcrowding rate, standardised immigration rate by sex, educational level, unemployment rate, average spending per person in euros, AIDS rate and the influenza incidence rate. The geostatistical method shows spatial variability of the risk with higher risks in the northwest and southeast of the peninsula. CONCLUSION: Results prove that the co-kriging method is a useful tool to show the spatial distribution of risk. Alternatively, tuberculosis is associated with both social and epidemiological covariates.

Modelling of municipal mortality due to haematological neoplasias in Spain.

OBJECTIVES: To study the geographical pattern of mortality caused by haematological tumours in Spain at the municipal level using three Bayesian models and to compare their goodness of fit. METHODS: The fitted Bayesian hierarchical models were: (1) the Besag York and Molliè (BYM) model; (2) a model based on zero-inflated Poisson (ZIP) distribution, which allowed a large number of event-free areas; and (3) a mixture of distributions that enabled discontinuities (jumps in the pattern) to be modelled. The three models allow smoothed relative risk maps to be obtained for the all countries. The goodness of fit was evaluated using the deviance information criteria. RESULTS: The three models yielded similar results. The ZIP model plotted a pattern almost identical with the BYM model. The goodness-of-fit criteria indicate that the mixture model is the one that best fits our data. Haematological tumours display a geographical pattern that could be partly explained by environmental determinants, as many of the highest-risk towns are located in heavily industrialised areas. CONCLUSIONS: The choice of one or another model has scant practical consequences. The pattern of distribution supports the hypothesis that differences in lifestyles, air/industrial pollution and migratory phenomena may determine the pattern of urban mortality due to these tumours.