Cost-effectiveness of rifampin for 4 months and isoniazid for 6 months in the treatment of tuberculosis infection.

OBJECTIVES: To assess the cost-effectiveness ratio of rifampin for 4 months and isoniazid for 6 months in contacts with latent tuberculosis infection. METHODS: The cost was the sum of the cost of treatment with isoniazid for 6 months or with rifampin for 4 months of all contacts plus the cost of treatment of cases of tuberculosis not avoided. The effectiveness was the number of cases of tuberculosis avoided with isoniazid for 6 months or with rifampin for 4 months. When the cost with one schedule was found to be cheaper than the other and a greater number of tuberculosis cases were avoided, this schedule was considered dominant. The efficacy adopted was 90% for rifampin for 4 months and 69% for isoniazid for 6 months. A sensitivity analysis was made for efficacies of rifampin for 4 months of 80%, 69%, 60% and 50%. RESULTS: Of the 1002 patients studied, 863 were treated with isoniazid for 6 months and 139 with rifampin for 4 months The cost-effectiveness ratio with isoniazid for 6 month was € 19759.48/avoided case of tuberculosis and € 8736.86/avoided case of tuberculosis with rifampin for 4 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies from 60%. CONCLUSIONS: Rifampin for 4 months was more cost-effective than isoniazid for 6 months.

[Assessing the effectiveness of vaccination programs]. / Evaluación de la efectividad de los programas de vacunación.

Vaccines have contributed enormously to reducing the incidence of many communicable diseases. The protective efficacy of a vaccine refers to the health effects of the vaccine applied in optimal, ideal conditions, whereas the effectiveness of a vaccination program refers to the health effects of vaccination in the vaccinated individuals in clinical practice or within public health programs, which may differ widely from optimal conditions. Vaccine efficacy is estimated by randomized clinical trials. In contrast, effectiveness can be measured by various types of epidemiological studies: randomized community trials, in which the target vaccine is randomly assigned to a group and disease incidence in this group is compared with that of an unvaccinated group; cohort studies, which are observational epidemiological studies in which the vaccination status is known in healthy vaccinated (vaccinated cohort) and unvaccinated (unvaccinated cohort) people and the occurrence of the disease in the two groups is studied; and observational case-control studies, in which two groups are selected; one with the disease under investigation (cases) and the other without (controls), and vaccination histories are investigated in the two groups. Vaccine effectiveness may also be estimated by comparing attack rates in epidemic outbreaks or secondary attack rates in the home, or by screening.

Influence of prior pneumococcal and influenza vaccination on outcomes of older adults with community-acquired pneumonia.

OBJECTIVES: To determine whether prior pneumococcal and seasonal influenza vaccination improves outcomes in older adults hospitalized for community-acquired pneumonia (CAP). DESIGN: Prospective, observational, multicenter study. SETTING: Five public hospitals providing universal free care to the whole population in three Spanish regions. PARTICIPANTS: Individuals aged 65 and older admitted to the hospital with CAP through the emergency department. MEASUREMENTS: Pneumococcal and influenza vaccination status. The primary study outcomes were intensive care unit (ICU) admission, length of hospital stay (LOS), and overall case-fatality rate. Outcome variables of individuals vaccinated with both vaccines were compared with outcomes of those who were unvaccinated. RESULTS: Two hundred thirty-eight individuals had received 23-valent pneumococcal polysaccharide vaccine and seasonal influenza vaccination and were compared with 195 unvaccinated individuals. No differences were found with respect to combined antibiotic therapy between groups (38.0% vs 39.7%; P = .80). Similar percentages of vaccinated and unvaccinated individuals required ICU admission (7.2% vs 8.2%; P = .69). Mean LOS was significantly shorter in vaccinated individuals (9.9 vs 12.4 days; P = .04). Overall case-fatality rates were similar in both groups (5.9% vs 5.1%; P = .73). After adjustment, LOS, risk of ICU admission, and overall case-fatality rate were not associated with prior pneumococcal and seasonal influenza vaccination. CONCLUSION: The clinical outcomes of vaccinated older adults hospitalized with CAP were not better than those observed in unvaccinated individuals.

Evaluación de la efectividad de los programas de vacunación / Assessing the effectiveness of vaccination programs

Las vacunas han contribuido enormemente a la reducción de la incidencia de muchas enfermedades transmisibles. La eficacia protectora de una vacuna se refiere a los efectos sanitarios de la vacuna aplicada en condiciones óptimas e ideales, mientras que la efectividad de un programa de vacunación evalúa los efectos sanitarios en los individuos vacunados, cuando las condiciones de aplicación son las habituales de la práctica clínica o de los programas de salud pública, distantes de las óptimas. La eficacia de la vacuna se estima en ensayos clínicos aleatorizados. Por su parte, la efectividad puede estimarse mediante diversos tipos de, estudios epidemiológicos: ensayos comunitarios aleatorizados, en los que se asigna aleatoriamente la vacuna objeto de estudio a un grupo como unidad de aleatorización y se compara la incidencia de la enfermedad en dicho grupo con la del otro grupo que no se ha vacunado; estudios de cohortes, tipo de estudio epidemiológico observacional en que se parte del antecedente de la vacunación en sujetos sanos vacunados (cohorte vacunada) y no vacunados (cohorte no vacunada), y se investiga la aparición de la enfermedad en ambos grupos; y estudios de casos y controles, también observacionales, en los cuales se seleccionan dos grupos, uno con presencia (casos) y otro con ausencia (controles) de la enfermedad que se desea prevenir, y se retrocede al pasado en busca de los antecedentes de vacunación en ambos grupos. También puede estimarse comparando las tasas de ataque en los brotes epidémicos, o las tasas de ataque secundario en el ámbito familiar, o mediante el método de cribado (AU)

Vaccines have contributed enormously to reducing the incidence of many communicable diseases. The protective efficacy of a vaccine refers to the health effects of the vaccine applied in optimal, ideal conditions, whereas the effectiveness of a vaccination program refers to the health effects of vaccination in the vaccinated individuals in clinical practice or within public health programs, which may differ widely from optimal conditions. Vaccine efficacy is estimated by randomized clinical trials. In contrast, effectiveness can be measured by various types of epidemiological studies: randomized community trials, in which the target vaccine is randomly assigned to a group and disease incidence in this group is compared with that of an unvaccinated group; cohort studies, which are observational epidemiological studies in which the vaccination status is known in healthy vaccinated (vaccinated cohort) and unvaccinated (unvaccinated cohort) people and the occurrence of the disease in the two groups is studied; and observational case-control studies, in which two groups are selected; one with the disease under investigation (cases) and the other without (controls), and vaccination histories are investigated in the two groups. Vaccine effectiveness may also be estimated by comparing attack rates in epidemic outbreaks or secondary attack rates in the home, or by screening (AU)

Validity of self-reported pneumococcal vaccination status in the elderly in Spain.

The objective of this study was to evaluate the validity of information reported by the elderly on 23-valent pneumococcal polysaccharide vaccine (23vPPV) vaccination status. A cross-sectional, observational study was carried out in patients aged >or=65 years admitted to five Spanish hospitals. Data on 23vPPV vaccination history were obtained through interview of the patient or close relative and review of written medical information. The validity of the patient self-report was compared to the written medical information by calculation of the sensitivity, specificity, concordance, positive predictive value (PPV) and negative predictive value (NPV). A total of 2484 patients were initially included of whom 1814 patients (73%) responded about their vaccination status. The global sensitivity of the patient self-report was 0.74 and the specificity 0.95. The PPV was 0.92, the NPV 0.84 and the concordance 87. Vaccination cards and centralized vaccination registries in primary health care centres and hospitals should be potentiated in order to ensure that neither more nor less vaccinations are administered than are necessary.

Impacto de la vacuna neumocócica conjugada heptavalente en una población con valores bajos-intermedios de vacunación / Impact of 7-valent pneumococcal conjugate vaccination in a population with low to intermediate vaccination levels

Objetivo: Analizar la evolución de los casos declarados (notificación microbiológica) de enfermedad neumocócica invasora (ENI) en niños menores de 2 años de Cataluña (España) después de la comercialización de la vacuna neumocócica conjugada heptavalente. Material y métodos: Los casos de ENI en los niños menores de 2 años se han obtenido a partir de las declaraciones efectuadas al Sistema de Notificación Microbiológica de Cataluña durante los períodos 1997¿1999 y 2002¿2004 por los hospitales (n=23) que han participado de forma continuada e ininterrumpida en este sistema desde su puesta en marcha en 1995. Resultados: Las tasas globales de casos declarados fueron de 49,2 por 100.000 personas-año durante el período 1997¿1999 y de 40,4 por 100.000 personas-año en el período 2002¿2004. La diferencia no fue estadísticamente significativa. Las tasas de neumonías bacteriémicas pasaron de 25,2 por 100.000 personas-año en 1997¿1999 a 21,6 por 100.000 personas-año en 2002¿2004, y las de meningitis de 6,0 a 4,3 por 100.000 personas-año, respectivamente, pero en ambos casos las diferencias no alcanzaron significación estadística (p>0,05). Conclusiones: Después de la comercialización de la vacuna neumocócica conjugada heptavalente, se ha producido una cierta reducción, no estadísticamente significativa, en las tasas de notificaciones de la enfermedad neumocócica invasora en los niños menores de 2 años de Cataluña. En caso de haber alcanzado significación estadística, la reducción global habría sido del 17,90%, no muy lejana de la reducción teóricamente esperada (22%), a partir de la eficacia protectora de la vacuna (89%), el porcentaje de serotipos causantes de enfermedad invasora incluidos en la vacuna (70%) y las coberturas vacunales alcanzadas durante el período analizado (35%) (AU)

Objective: To analyze the changes occurring in declared cases (microbiological report) of invasive pneumococcal disease (IPD) in children <2 years old in Catalonia (Spain) after the 7-valent pneumococcal conjugate vaccine (PCV7) was licensed for use. Material and methodsCases of IPD in children <2 years old were obtained from notifications to the Microbiological Reporting System of Catalonia (MRSC) in 1997¿1999 and 2002¿2004 by the hospitals (n=23) that have participated in the MRSC continuously and uninterruptedly since its inception in 1995. Results: Overall reported rates were 49.2 cases per 100,000 persons-year in 1997¿1999 and 40.4 per 100,000 persons-year in 2002¿2004; the difference was not statistically significant. The rate of bacteremic pneumonia fell from 25.2 per 100,000 persons-year in 1997¿1999 to 21.6 per 100,000 persons-year in 2002¿2004, and meningitis from 6.0 to 4.3 per 100,000 persons-year; again, differences were not statistically significant (P>0.05). Conclusions: After PCV7 was licensed for use, a noticeable, but non-significant, reduction in reported IPD rates in children <2 years old occurred in Catalonia. If the results had been statistically significant, the overall reduction would have been 17.90%, not far below the theoretically expected reduction (22%), based on the protective efficacy of PCV7 (89%), the percentage of invasive disease-causing serotypes included in the vaccine (70%), and the vaccination coverage achieved during the study period (35%) (AU)

[Impact of 7-valent pneumococcal conjugate vaccination in a population with low to intermediate vaccination levels]. / Impacto de la vacuna neumocócica conjugada heptavalente en una población con valores bajos-intermedios de vacunación.

OBJECTIVE: To analyze the changes occurring in declared cases (microbiological report) of invasive pneumococcal disease (IPD) in children <2 years old in Catalonia (Spain) after the 7-valent pneumococcal conjugate vaccine (PCV7) was licensed for use. MATERIAL AND METHODS: Cases of IPD in children <2 years old were obtained from notifications to the Microbiological Reporting System of Catalonia (MRSC) in 1997-1999 and 2002-2004 by the hospitals (n=23) that have participated in the MRSC continuously and uninterruptedly since its inception in 1995. RESULTS: Overall reported rates were 49.2 cases per 100,000 persons-year in 1997-1999 and 40.4 per 100,000 persons-year in 2002-2004; the difference was not statistically significant. The rate of bacteremic pneumonia fell from 25.2 per 100,000 persons-year in 1997-1999 to 21.6 per 100,000 persons-year in 2002-2004, and meningitis from 6.0 to 4.3 per 100,000 persons-year; again, differences were not statistically significant (P>0.05). CONCLUSIONS: After PCV7 was licensed for use, a noticeable, but non-significant, reduction in reported IPD rates in children <2 years old occurred in Catalonia. If the results had been statistically significant, the overall reduction would have been 17.90%, not far below the theoretically expected reduction (22%), based on the protective efficacy of PCV7 (89%), the percentage of invasive disease-causing serotypes included in the vaccine (70%), and the vaccination coverage achieved during the study period (35%).

Seroepidemiology of hepatitis B virus infection in pregnant women in Catalonia (Spain).

BACKGROUND: In recent years there has been a substantial reduction in hepatitis B incidence as a result of routine vaccination of preadolescents and the selective vaccination of high risk groups and newborns of HBsAg+ mothers. OBJECTIVES: To determine the prevalence of hepatitis B virus infection markers and of serologic markers of hepatitis B vaccination in a representative sample of pregnant women in Catalonia. STUDY DESIGN: A representative sample was obtained by random cluster sampling (hospitals with maternity units) stratified by provinces. Anti-HBc, anti-HBs and HBsAg were determined using an ELISA test (Behring, Marburg, Germany). The crude and adjusted odds ratios for the sociodemographic variables analyzed were also calculated. RESULTS: The global prevalence of carriers of HBsAg+ was 0.1% (95% CI 0.0-0.3), that of hepatitis B infection (anti-HBc+) was 5% (95% CI 3.9-6.1) and that of serologic markers of vaccination (anti-HBs+ and anti-HBc-) was 16.4% (95% CI 14.5-18.2) The prevalence of infection increased with age from 3.0% (15-19 years age group) to 14.8% (40-44 years age group). The prevalence of anti-HBc+ was higher in women born in Asia (27.6%) and Africa (18.8%) than in those born in Spain (3.7%), Europe (3.3%) and America (4.6%), with the differences being statistically significant. CONCLUSIONS: The results of this study confirm the change in the pattern of endemicity of hepatitis B infection in pregnant women in Catalonia after the introduction of vaccination programmes. They also confirm the increasingly important role played by immigration in the epidemiology of hepatitis B.

Seroprevalence of varicella zoster virus infection in child and adult population of Catalonia (Spain).

The aim of this study was to determine the prevalence of varicella IgG antibodies in the population of Catalonia, and the variables associated. The study was carried out in 2002 in a representative sample of juvenile (5-14 years) and adult population (> or =15 years) of Catalonia (Spain). The global prevalence determined by ELISA test was 95.5% (95% CI 94.7-96.3). The prevalence increased with age, from 82% (95% CI 77.0-87.0) in the 5-9 years age up to 99.4% (95% CI 98.2-100) in >64 years of age. No statistically significant differences in the seroprevalence according to the sociodemographic variables were observed. The current strategy of vaccinating preadolescents at 12 years of age who have not suffered the disease will require more than 30 years to cover the current gap immunity in adolescents and young adults. Vaccination with two doses of vaccine for all adolescents and adults < or = 50 years who report not having suffered the disease during childhood should be considered.

Trends in dietary habits and food consumption in Catalonia, Spain (1992-2003).

OBJECTIVE: To analyse trends in food habits and food consumption from 1992 to 2003. DESIGN: Two consecutive cross-sectional nutrition surveys were carried out on random samples of the Catalan population (Evaluation of Nutritional Status in Catalonia (ENCAT) 1992-93 and ENCAT 2002-03). Dietary intake was assessed by means of two 24-hour recalls on non-consecutive days and a food frequency questionnaire was used to ascertain tendencies in the frequency of food consumption. SETTING: Catalonia region, Northeastern Spain. SUBJECTS: Analysis is based on a total of 4701 individuals: 2641 from ENCAT 1992-93 (1210 men and 1431 women) and 2060 from ENCAT 2002-03 (954 men and 1106 women), aged 10-75 years. RESULTS: The trends from 1992 to 2003 showed an increase in eating between meals and outside the home. There was also an upsurge in consumers for fast food, especially among young adults. Notable decreases in fruit consumption (from 301 to 224 g day(-1)) as well as in vegetables, potatoes, meat (red meat and chicken), fish (whitefish and seafood) and offals were observed. In contrast, there was an increase in dairy product consumption, in general (from 255 to 312 g day(-1)), as well as low fat and skim milk derivatives. Fruit juice, nuts and olive oil consumption also increased, the latter being consumed daily by 96% of the population. Little variation was observed for the rest of the food groups in the period studied. Overall, Catalonia is characterised by a model of consumption that is quite favourable, inherent to Mediterranean countries but with important differences according to age. CONCLUSION: Based on the food consumption trends observed in Catalonia, an increase in the consumption of fruits and vegetables, as well as whole grain cereals and fish, should be promoted, along with a reduction in the consumption of meat and sausages.

Obesity and overweight trends in Catalonia, Spain (1992-2003): gender and socio-economic determinants.

OBJECTIVE: To evaluate the trends of overweight and obesity prevalences in the population of Catalonia, Spain, aged 18-75 years, and the influence of socio-economic determinants on these prevalence trends. DESIGN: Analysis based on data from two representative population-based cross-sectional surveys. SETTING: Data from the two Evaluations of Nutritional Status in Catalonia (ENCAT 1992-93 and ENCAT 2002-03), Spain. Weights and heights were obtained by direct measurement in standardised conditions by trained interviewers. Overweight and obesity were defined using body mass index (BMI) and waist circumference (WC), categorised according to WHO criteria. SUBJECTS: In total, 1015 men and 1233 women from ENCAT 1992-93, and 791 men and 924 women from ENCAT 2002-03. RESULTS: Mean BMI and mean WC were higher in males in 2002-03 as compared to 1992-93, while for females mean BMI was lower except for the youngest group, and mean WC was higher. In men, overall BMI overweight prevalence remained stable (from 44.1% to 43.7%), while obesity increased (from 9.9% to 16.6%); total WC overweight remained stable (from 21.7 to 23.8%), while WC obesity increased (from 13.1% to 24.4%). In women, overall BMI overweight increased (from 29.1% to 30.1%), whereas BMI obesity remained stable (from 15.0% to 15.2%); total WC overweight decreased (from 21.8% to 17.7%), while WC obesity increased (from 24.5% to 31.1%). The socio-economic and education variables had an influence on BMI and WC overweight and obesity rates mainly on females in both surveys and on the youngest men only in the 1992-93 survey. CONCLUSIONS: Ten-year trends indicate that Catalan males are getting bigger overall (BMI) and around the waistline (WC), while Catalan females only have bigger waistlines (WC). BMI male obesity prevalence has overtaken that of females. WC obesity continues to be more prevalent among females than males.

Trends in blood lipids and fat soluble vitamins in Catalonia, Spain (1992-2003).

OBJECTIVE: The purpose of this study was to assess the 10-year trend in lipid and antioxidant vitamin levels in the Catalan population from 1992 to 2003. DESIGN: Two cross-sectional surveys were carried out in Catalonia, Spain, during 1992-93 and 2002-03. A subsample of the individuals participating in the surveys agreed to undergo a biochemical evaluation. SUBJECTS: Eight hundred and eighty individuals (393 males and 487 females) in the 1992-93 nutritional survey and 429 individuals (205 males and 224 females) in the 2002-03 nutritional and health survey. The subjects' ages ranged from 18 to 74 years. RESULTS: Mean total cholesterol decreased from 5.3 to 5.1 mmol l(-1) (P < 0.005), and the prevalence of hypercholesterolaemia decreased, especially in males (from 23% to 10% in males from 50 to 64 years old, P < 0.05). Mean cholesterol high-density lipoprotein (HDL) values decreased in the entire sample (from 1.4 to 1.3 mmol l(-1), P < 0.001) and there was an increase in the percentage of population with low values of HDL (from 10% to 19%, P < 0.001). An increase in the percentage of the population with values of alpha-tocopherol at marginal risk levels (from 6% to 9%) and with low values of beta-carotene (from 59% to 66%) was observed. The mean values for retinol increased in both males (from 1.99 to 2.44 micrommol l(-1), P < 0.001) and females (from 1.69 to 2.29, P < 0.001). CONCLUSION: Although there was a decrease in the percentage of population with hypercholesterolaemia, the decrease in HDL cholesterol worsened the lipid profile of the Catalan population. The increase in the values of some antioxidant vitamins did not affect the entire population since an increase in the number of individuals with marginal values was observed.

Declining hepatitis A seroprevalence in adults in Catalonia (Spain): a population-based study.

BACKGROUND: One of the main uses of seroprevalence studies it to evaluate vaccination programmes. In 1998, a programme of universal vaccination of preadolescents in schools with the hepatitis A vaccine was begun in Catalonia. The objective of this study was to investigate the prevalence and risk factors of hepatitis A virus infection (HAV) in a sample of the adult population of Catalonia in 2002 and to evaluate the changes with respect to a survey carried out in 1996. METHODS: The prevalence of HAV antibodies was determined by a third generation competitive immunometric assay in a representative sample of 1292 people aged >15 years. The association between the prevalence and different sociodemographic variables was determined by multiple logistic regression analysis. RESULTS: The standardized global prevalence of HAV antibodies in 2002 was 68.2%, increased with age (p < 0.0001) and was associated with being born outside Catalonia (OR: 1.75; 95% CI 1.11-2.76) and lower social class (OR: 1.14; 95% CI 1.05-1.25). Compared with the last survey carried out in 1996 the standardized global prevalence was lower (68.2% vs 77.8%; p < 0.0001) as was the prevalence in people under 45 years. CONCLUSION: The prevalence of the hepatitis A virus is decreasing in the adult population of Catalonia, especially in the younger age groups. The programme of vaccination of adolescents begun in 1998 to control the disease can provide indirect protection to the unvaccinated population.

Rubella immune status of indigenous and immigrant pregnant women in Catalonia, Spain.

BACKGROUND: The objective of the study was to determine the prevalence of rubella antibodies in representative samples of pregnant women in Catalonia. METHODS: A representative sample of pregnant women in Catalonia was obtained by random sampling by clusters (hospitals with maternity units) stratified by provinces. Blood was obtained from the umbilical cord at childbirth in 1538 women (of whom 308 were immigrants) and was tested for rubella antibodies by ELISA (Enzime-linked immunosorbent assay). RESULTS: The global prevalence of antibodies was 93.4% [95% confidence interval (CI): 93.3-93.5] and was significantly higher in indigenous women (94.9;95%CI:93.3-95.9) compared with immigrants [89.0; 95%CI: 85.5-92.5 (P<0. 0001)] with crude Odds ratio (OR) of 2.15 (95%CI: 1.40-3.32).The prevalence was higher in women living in rural habitats (97%) and those in higher social classes (96.3%); OR 2.54 (95%CI: 1.22-5.30) and 2.17 (95%CI: 1.24-3.81), respectively. CONCLUSION: Fertile female immigrants from countries with no vaccination or where vaccination coverage is low should be actively approached for vaccination to reduce the risk of infection and congenital rubella.

Non-preventable mumps outbreaks in schoolchildren in Catalonia.

Various doses of the combined MMR vaccine containing the Rubini mumps strain were distributed in Catalonia in 1994 and 1995. We studied outbreaks of mumps reported from 1997 to 2002 to determine the possible involvement of this vaccine in the appearance of non-preventable mumps outbreaks. A total of 17 mumps outbreaks were declared in the period 1997-2000, 14 of which were in schoolchildren. In 11, it was determined that children were correctly vaccinated. Of these, 10 were non-preventable outbreaks. 66% of cases investigated had ages which coincided with vaccination in the period 1994-1996, during which the MMR vaccine containing the Rubini mumps strain was administered. In Catalonia, during the period 1997-2000, at least two-thirds of mumps cases in schoolchildren could be explained by vaccination with the combined MMR vaccine containing the Rubini strain, which has also been associated with mumps outbreaks amongst vaccinated people in other countries.

Vacuna de la hepatitis B y esclerosis múltiple: una asociación no probada / Hepatitis B vaccine and multiple sclerosis: an unproved association

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Rubella elimination programme strengthened through measles elimination programme in Catalonia.

The drastic fall in rubella cases recorded in Catalonia from 1988 on, when the second dose of Measles-Mumps-Rubella (MMR) vaccine was implemented, and especially from 1998, when the measles elimination programme began, led to the introduction, in May 2002, of the rubella and congenital rubella syndrome elimination by 2005 programme. From May 2002 to May 2004, 13 suspected rubella cases were reported to the Statutory Disease Reporting System; of these, one postnatal case and one congenital rubella case were confirmed (15.4%), both being imported cases. Through the screening of viruses established in the measles elimination programme, 28 possible cases were analyzed and six (21.4%) confirmed imported postnatal rubella cases were detected. The small number and imported nature of the cases of rubella and the detection of the majority of the confirmed cases through the measles elimination programme, strongly suggests that both programmes should continue.

Effectiveness of pneumococcal vaccination for elderly people in Catalonia, Spain: a case-control study.

BACKGROUND: Observational studies offer an approach to evaluating the effectiveness of vaccination programs. We evaluated the effectiveness of a 23-valent pneumococcal vaccination program for elderly people in Catalonia, Spain, in a matched-set case-control study. METHODS: We identified 149 cases of invasive pneumococcal disease among patients aged > or =65 years who were hospitalized in 12 large hospitals in Catalonia during the period of 1 January 2001 through 31 March 2002. We selected 2 hospital control patients and 1 outpatient control subject for each case patient, matching on the basis of age and underlying medical conditions. We obtained their pneumococcal vaccination histories and used conditional logistic regression to determine effectiveness of vaccination. RESULTS: Among all 149 cases of invasive pneumococcal disease, 131 (87.9%) were caused by vaccine or vaccine-related serotypes. In the adjusted analysis, overall effectiveness of vaccination against infections due to all serotypes was 70% (95% confidence interval [CI], 48%-82%). Among immunocompetent subjects with or without high-risk conditions, effectiveness of vaccination was 76% (95% CI, 51%-88%), but among immunocompromised subjects it was 50% (95% CI, -44% to 82%). Among subjects with infections due to vaccine or vaccine-related serotypes, effectiveness of vaccination was 72% (95% CI, 50%-85%) overall and 78% (95% CI, 50%-90%) in those who were immunocompetent, but it was only 46% (95% CI, -54% to 81%) in those who were immunocompromised. Overall effectiveness of vaccination was 65% (95% CI, 35%-81%) during the noninfluenza period. CONCLUSIONS: Pneumococcal vaccination was effective in preventing invasive pneumococcal disease among all elderly persons in Catalonia. Effectiveness was greater in immunocompetent persons, most of whom had underlying high-risk conditions. The number of subjects was too small to determine whether vaccination was effective in those who were immunocompromised.

A brief measure of high nicotine dependence for busy clinicians and large epidemiological surveys.

OBJECTIVE: It is important to perform a routine screening of nicotine dependence in psychiatric patients. The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. The Heavy Smoking Index (HSI) is a briefer measure including only two FTND items (time to first cigarette of day and number of daily cigarettes). In a prior study comparing HSI with FTND, a high HSI (score > or = 4) was a good and briefer alternative for detecting high nicotine dependence. The goals of this study were: (i) to compare the effectiveness of the HSI with the effectiveness of Items 1 and 4 alone for the screening of high nicotine dependence; (ii) to investigate the optimality of 4 as a cut-off score for the HSI so that the HSI can be used as a binary indicator of high nicotine dependence; and (iii) to compare the sensitivity and specificity of four indexes of high nicotine dependence, namely 'High HSI', 'Very Early Smoking', 'Heavy Smoking' and 'High in Either Item'. METHOD: The FTND was administered to 819 current daily smokers from a general population survey. As in a prior study, an FTND score > or = 6 was considered the reference or 'gold standard' test for detecting high nicotine dependence. Receiver-operating characteristic analyses were performed. RESULTS: This new study using more sophisticated statistical methodology verified that a cut-off of 4 for the HSI is appropriate and that the 'high' HSI has good sensitivity and specificity even across different population subclassifications. CONCLUSIONS: With four questions (smoking, daily smoking, time to first cigarette of day and number of daily cigarettes) and minimal calculations, it may be possible to screen whether a smoker has high nicotine dependence. If other studies in other populations and settings verify this finding, this brief measure might be an ideal screening instrument for busy clinicians, epidemiologists developing questionnaires for health surveys and psychiatric researchers.