Lifting COVID-19 mitigation measures in Spain (May-June 2020).

Introduction: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. Methods: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. Results: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. Conclusion: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.

Introducción: El 14 de marzo de 2020 España declaró el estado de alarma por la pandemia por COVID-19 incluyendo medidas de confinamiento. El objetivo es describir el proceso de desescalada de estas medidas. Métodos: Un plan de transición hacia una nueva normalidad, del 28 de abril, incluía 4 fases secuenciales incrementando progresivamente las actividades socioeconómicas y la movilidad. Concomitantemente, se implementó una nueva estrategia de diagnóstico precoz, vigilancia y control. Se estableció un mecanismo de decisión bilateral entre Gobierno central y comunidades autónomas (CCAA), guiado por un panel de indicadores cualitativos y cuantitativos de la situación epidemiológica y las capacidades básicas. Las unidades territoriales evaluadas comprendían desde zonas básicas de salud hasta CCAA. Resultados: El proceso se extendió del 4 de mayo al 21 de junio y se asoció a planes de refuerzo de las capacidades en las CCAA. La incidencia disminuyó de una mediana inicial de 7,4 por 100.000 en 7 días a 2,5 al final del proceso. La mediana de pruebas PCR aumentó del 53% al 89% de los casos sospechosos, y la capacidad total de 4,5 a 9,8 pruebas semanales por 1.000 habitantes; la positividad disminuyó del 3,5% al 1,8%. La mediana de casos con contactos trazados aumentó del 82% al 100%. Conclusión: La recogida y análisis sistemático de información y el diálogo interterritorial logaron un adecuado control del proceso. La situación epidemiológica mejoró, pero sobre todo, se aumentaron las capacidades, en todo el país y con criterios comunes, cuyo mantenimiento y refuerzo fue clave en olas sucesivas.

Lifting COVID-19 mitigation measures in Spain (May-June 2020).

INTRODUCTION: The state of alarm was declared in Spain due to the COVID-19 epidemic on March 14, 2020, and established population confinement measures. The objective is to describe the process of lifting these mitigation measures. METHODS: The Plan for the Transition to a New Normality, approved on April 28, contained four sequential phases with progressive increase in socio-economic activities and population mobility. In parallel, a new strategy for early diagnosis, surveillance and control was implemented. A bilateral decision mechanism was established between the Spanish Government and the autonomous communities (AC), guided by a set of qualitative and quantitative indicators capturing the epidemiological situation and core capacities. The territorial units were established ad-hoc and could be from Basic Health Zones to entire AC. RESULTS: The process run from May 4 to June 21, 2020. AC implemented plans for reinforcement of core capacities. Incidence decreased from a median (50% of territories) of 7.4 per 100,000 in 7 days at the beginning to 2.5 at the end. Median PCR testing increased from 53% to 89% of suspected cases and PCR total capacity from 4.5 to 9.8 per 1000 inhabitants weekly; positivity rate decreased from 3.5% to 1.8%. Median proportion of cases with traced contacts increased from 82% to 100%. CONCLUSION: Systematic data collection, analysis, and interterritorial dialogue allowed adequate process control. The epidemiological situation improved but, mostly, the process entailed a great reinforcement of core response capacities nation-wide, under common criteria. Maintaining and further reinforcing capacities remained crucial for responding to future waves.

[Long-term care facilities (LTCF) for the elderly: the surveillance of communicable diseases as part of health care and protection.] / Centros residenciales de mayores: la vigilancia de las enfermedades transmisibles como parte del cuidado y la protección de la salud.

During the last decades, healthcare has undergone important changes. Increased life expectancy has given rise to an aging population that, according to the United Nations, is about to become one of the most important social transformations of the 21st century. Globally, there were 727 million people aged 65 or over in 2020 (9.3% of the total population) and this is estimated to increase to 16% by 2050 . In the European Union (EU), the percentage of the population aged 65 or over has increased from 9.6% in 1960 to 20.3% in 2019 and is projected to increase to 31.3% by 2100. We are also witnessing a process of aging of the elderly population, with a proportion of very old people (those aged 80 and over) in the total population of the European Union of 5.8% in 2019 . Spain is one of the countries with the highest proportion of older people, with a percentage of citizens aged 65 or over in 2020 of 19.6% of the total population, and with a projection of 26.5% for 2035. Almost a third of this population (6%) are 80 years or older.

Durante las últimas décadas la asistencia sanitaria ha sufrido importantes cambios. La mayor esperanza de vida ha dado lugar a un envejecimiento de la población que, según las Naciones Unidas, está a punto de convertirse en una de las más importantes transformaciones sociales del siglo XXI. A nivel mundial, había 727 millones de personas de 65 años o más en 2020 (un 9,3% de la población total) y se estima que aumente al 16% en 2050 . En la Unión Europea (UE), el porcentaje de población de 65 años o más se ha incrementado de un 9,6% en 1960 a un 20,3% en 2019 y se proyecta que aumente a un 31,3% para 2100. Asistimos además a un proceso de envejecimiento de la población mayor, con una proporción de personas muy mayores (aquellas de 80 años y más) en la población total de la Unión Europea del 5,8% en 2019 . España es uno de los países con una mayor proporción de personas mayores, con un porcentaje de ciudadanos de 65 años o más en 2020 del 19,6% del total de la población, y con una proyección del 26,5% para 2035. Casi un tercio de esta población (6%) tienen 80 años o más.

[Lessons learnt from COVID-19 surveillance. Urgent need for a new public health surveillance. SESPAS Report 2022]. / Lecciones de la vigilancia de la COVID-19. Necesidad urgente de una nueva vigilancia en salud pública. Informe SESPAS 2022.

In this article we provide the most important epidemiological aspects in the first phases of the pandemic and some preliminary reflections from the Coordinating Centre for Health Alerts and Emergencies, the unit that has coordinated surveillance at the national level. COVID-19 has brought to light the weaknesses in the surveillance system and how difficult it is to manage a health crisis in the absence of a robust public health structure. The commitment of public health professionals during this epidemic has made up for the lack of resources in many occasions, and has evidenced the need to incorporate new professional profiles to surveillance teams. The need to rapidly adapt has achieved an improvement in existing systems and the development of new tools and new systems. These need to turn into structural changes that improve the quality of surveillance, decreasing territorial gaps and ensuring a better and coordinated response to future health crises. It is urgent to incorporate tools for process automation and to grant timely availability of data. To that end, public health and epidemiological surveillance must participate in the process of digital development within the National Health System. Profound changes are needed in public health surveillance, which has to be integrated in all healthcare levels. It is also important to strengthen the capacity for analysis by promoting alliances and joint actions. During this alert, the importance of coordination in public health in a decentralized country has been evident. At international level, it is necessary to review the tools to share data to coordinate an alert from the early stages.

Mpox (formerly monkeypox) in women: epidemiological features and clinical characteristics of mpox cases in Spain, April to November 2022.

Over 79,000 confirmed cases of mpox were notified worldwide between May and November 2022, most of them in men who have sex with men. Cases in women, for whom mpox might pose different risks, are rare, and Spain has reported more than one third of those in Europe. Using surveillance data, our study found similar time trends, but differences in delay of diagnosis, sexual transmission and signs and symptoms between men and women.

An imported case of vaccine-derived poliovirus type 2, Spain in the context of the ongoing polio Public Health Emergency of International Concern, September 2021.

The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.

[COVID-19 outbreaks in occupational settings in Spain, one year of follow-up (June 2020-June 2021).] / Brotes de COVID-19 en el ámbito laboral en España, un año de seguimiento (junio 2020-junio 2021).

COVID-19 outbreak surveillance in Spain was established with the main objective of characterizing outbreaks and the settings in which they occurred, in order to identify those population groups at highest risk to support them with the implementation of preventive and control measures. Between June 2020 and June 2021, 55,824 outbreaks were reported, with 414,882 cases in all settings. About 12.5% were reported in an occupational setting and within this, most of them were identified in the industry and building sectors. The outbreaks that had a greater impact were those that took place both in agriculture and in the meat industry, where there is a higher risk of exposure due to living and working conditions. Outbreaks in the catering and home care sectors were also frequent. Since the beginning, there was coordination between all stakeholders involved in the management of the pandemic, in order to implement prevention and control measures, as well as social protection measures. In addition, special actions were implemented in the most vulnerable sectors. Despite the work carried out, the presence of outbreaks in these sectors continues, although they are smaller than the previous pandemic phase. Due to this, there is needed to continue strengthening the inter-sectoral coordination structures and mechanisms to ensure the implementation of those measures that contribute to the containment of the pandemic.

La vigilancia de brotes COVID-19 en España se estableció con el objetivo de caracterizar los brotes y los ámbitos en los que ocurrían, con el propósito de identificar aquellos grupos de población con mayor riesgo para apoyar la toma de medidas de prevención y control. Entre junio de 2020 y junio de 2021 se comunicaron 55.824 brotes con 414.882 casos en todos los ámbitos. Alrededor del 12,5% de brotes y casos asociados fueron comunicados en el ámbito laboral y dentro de éste, la mayoría se identificó en los sectores de la industria y construcción, si bien, entre los brotes que han tenido un mayor impacto se encuentran aquellos producidos en el sector agrícola y en la industria de la carne, donde existe un mayor riesgo de exposición debido a las condiciones de vida y trabajo. También destacaron los brotes en el sector de la restauración y hostelería, y cuidados a domicilio. Desde el inicio hubo una coordinación entre las administraciones implicadas en la gestión de la pandemia para poner en marcha las medidas de prevención y control, así como las de protección social. Además, se llevaron a cabo medidas especiales en sectores de mayor vulnerabilidad. A pesar del trabajo realizado, los brotes en estos sectores continúan ocurriendo, si bien son de menor tamaño, por lo que se deben continuar fortaleciendo las estructuras y mecanismos de coordinación intersectoriales para la aplicación de las medidas que contribuyen además de la contención de la pandemia, a mantener activo el tejido productivo.

Unprecedented increase of West Nile virus neuroinvasive disease, Spain, summer 2020.

Cases of West Nile neuroinvasive disease (WNND) in Spain increased in summer 2020. Here we report on this increase and the local, regional and national public health measures taken in response. We analysed data from regional surveillance networks and the National Epidemiological Surveillance Network, both for human and animal West Nile virus (WNV) infection. During the 2020 season, a total of 77 human cases of WNV infection (median age 65 years; 60% males) were detected in the south-west of Spain; 72 (94%) of these cases developed WNND, presenting as meningoencephalitis, seven of which were fatal. In the previous two decades, only six human cases of WNND were detected in Spain. Reduced activities for vector control this season, together with other factors, might have contributed to the massive increase. Public health measures including vector control, campaigns to raise awareness among physicians and the general population, and interventions to ensure the safety of donations of blood products, organs, cells and tissues were effective to reduce transmission. Going forward, maintenance of vector control activities and an update of the vector-borne diseases response plan in Spain is needed.

[Zika virus epidemic. The Public Health response in Spain]. / Epidemia por virus Zika. Respuesta desde la salud púbica en España.

By mid-2015, an increase in the number of cases of microcephaly among newborns and neurologic disorders was detected in the Northwest of Brazil, which was possibly associated with Zika virus infection. Later on, this phenomenon was also observed in several Latin-American countries. In February 2016, the World Health Organization (WHO) on this basis, declared a Public Health Emergency of International Concern. From that moment on, several measures were adopted to achieve the epidemic control at both international and national levels. The WHO launched a strategic response plan based on case detection, infection control and treatment, as well as, the research and development of new vector control tools, diagnostic tests and vaccines. In Europe both surveillance and vector control systems were reinforced. The countries reporting most cases were France, Spain and the United Kingdom. In Spain, due to the high probability of case importation based on the close relationships with Latin-America, numerous measures were adopted to achieve a rapid response and an optimal control. Those included: the implementation of an active surveillance in collaboration with several experts, institutions and scientific societies; entomologic surveillance enhancement; the development of communication activities and recommendations for both healthcare workers and general population.

A mediados del 2015 se detectó en el noroeste de Brasil un incremento en el número de casos de microcefalia en recién nacidos y de alteraciones neurológicas, que se asociaron con una posible infección por el virus Zika y que más adelante comenzaría a observarse en otros países de Latinoamérica. En febrero de 2016 la Organización Mundial de la Salud (OMS) declaró esta situación como una Emergencia de Salud Pública de Importancia Internacional (ESPII) y desde ese momento se llevaron a cabo numerosas medidas para el control de la epidemia tanto a nivel internacional, como nacional en los diferentes países. La OMS lanzó un Plan de respuesta estratégico basado en la detección de casos, control de la infección y tratamiento, así como en la investigación y desarrollo de herramientas para el control de mosquitos, test diagnósticos y vacunas. En Europa se reforzaron los sistemas de vigilancia así como de control de los vectores, siendo los países que más casos notificaron: Francia, España y el Reino Unido. En España debido a la alta probabilidad de importación de casos por la estrecha relación con Latinoamérica, se llevaron a cabo numerosas medidas que permitieron una rápida respuesta y un óptimo control, que incluyeron: la puesta en marcha de una vigilancia activa en la que colaboraron diversos profesionales, organismos y sociedades científicas; el refuerzo de actividades de vigilancia entomológica; el desarrollo de actividades de comunicación y la elaboración de recomendaciones dirigidas a profesionales sanitarios y a la población general.

Epidemia por virus Zika. Respuesta desde la salud púbica en España / Zika virus epidemic. The Public Health response in Spain

A mediados del 2015 se detectó en el noroeste de Brasil un incremento en el número de casos de microcefalia en recién nacidos y de alteraciones neurológicas, que se asociaron con una posible infección por el virus Zika y que más adelante comenzaría a observarse en otros países de Latinoamérica. En febrero de 2016 la Organización Mundial de la Salud (OMS) declaró esta situación como una Emergencia de Salud Pública de Importancia Internacional (ESPII) y desde ese momento se llevaron a cabo numerosas medidas para el control de la epidemia tanto a nivel internacional, como nacional en los diferentes países. La OMS lanzó un Plan de respuesta estratégico basado en la detección de casos, control de la infección y tratamiento, así como en la investigación y desarrollo de herramientas para el control de mosquitos, test diagnósticos y vacunas. En Europa se reforzaron los sistemas de vigilancia así como de control de los vectores, siendo los países que más casos notificaron: Francia, España y el Reino Unido. En España debido a la alta probabilidad de importación de casos por la estrecha relación con Latinoamérica, se llevaron a cabo numerosas medidas que permitieron una rápida respuesta y un óptimo control, que incluyeron: la puesta en marcha de una vigilancia activa en la que colaboraron diversos profesionales, organismos y sociedades científicas; el refuerzo de actividades de vigilancia entomológica; el desarrollo de actividades de comunicación y la elaboración de recomendaciones dirigidas a profesionales sanitarios y a la población general

By mid-2015, an increase in the number of cases of microcephaly among newborns and neurologic disorders was detected in the Northwest of Brazil, which was possibly associated with Zika virus infection. Later on, this phenomenon was also observed in several Latin-American countries. In February 2016, the World Health Organization (WHO) on this basis, declared a Public Health Emergency of International Concern. From that moment on, several measures were adopted to achieve the epidemic control at both international and national levels. The WHO launched a strategic response plan based on case detection, infection control and treatment, as well as, the research and development of new vector control tools, diagnostic tests and vaccines. In Europe both surveillance and vector control systems were reinforced. The countries reporting most cases were France, Spain and the United Kingdom. In Spain, due to the high probability of case importation based on the close relationships with Latin-America, numerous measures were adopted to achieve a rapid response and an optimal control. Those included: the implementation of an active surveillance in collaboration with several experts, institutions and scientific societies; entomologic surveillance enhancement; the development of communication activities and recommendations for both healthcare workers and general population

[Differences in the recognition of occupational diseases by sex, occupation and business activity in Spain (1990-2009)]. / Reconocimiento de enfermedades profesionales según sexo, ocupación y actividad de la empresa en España (1999-2009.

BACKGROUND: According to official statistics, men suffer more occupational diseases (OD) than women. Nevertheless, the unequal distribution and participation in the labor markets between men and women should be kept in mind. The purpose was to assess the gender impact in the recognition of OD in Spain, examining interaction and confounding factors. METHODS: An incidence study of the occupational diseases declared through the official OD reporting forms from 1999 to 2009, provided by the General Subdirectorate of Social and Labor Statistics of the Ministry of Employment and Social Security, was conducted. The variables included were: reporting year, sex, age, occupation and economic activity of the company. Rates and crude relative risks (cRR) by these variables were calculated. Adjusted RR were also computed by using multivariate Poisson regression. RESULTS: During the study period a total of 243,310 OD were reported in Spain, with a sex ratio of men to women of 1.07. Correlation existed between occupation and business activity, thus the OD rates and RR were computed by these variables separately. By occupation, men had a crude RR of 1.067 (95%CI:1.058 to 1.076) versus women, while wen the analysis was adjusted by all the variables, the RR was 0.507 (95%CI:0.502 to 0.512). By economic activity of the company, the sense of risk was reversed too in the adjusted analysis (cRR=1.065, 95%CI:1.056 to 1.074 versus 0.632, 95%CI:0.626 to 0.638). CONCLUSIONS: Although crude OD rates were lower in women than in men during the period 1999-2009 in Spain, when these rates were adjusted by company activity or worker occupation, age and year of OD declaration, RRs become almost 50% higher in women than in men for the majority of occupations and types of company activity.

OBJETIVO: Según las estadísticas oficiales, los hombres sufren más enfermedades profesionales (EEPP) que las mujeres. No obstante, hay que tener presente su desigual distribución y participación en el mundo laboral. El objetivo de este estudio fue valorar cómo afecta el sexo al reconocimiento de EEPP en España, identificando posibles factores de interacción/confusión. METODOS: Se estudió la incidencia de las EEPP declaradas a través del Parte Oficial durante el período de 1999 al 2009 proporcionados por la Subdirección General de Estadísticas Sociales y Laborales del Ministerio de Empleo y Seguridad Social. Las variables incluidas fueron: año de declaración, sexo, edad, ocupación y actividad económica de la empresa. Se calcularon tasas y riesgos relativos (RR) crudos de EEPP por cada variable. Se estimaron los RR ajustados mediante análisis bivariable y multivariante de Poisson. RESULTADOS: Durante 1999-2009 se notificaron en España 243.310 EEPP, con una razón de tasas hombres/mujeres de 1,07. Hubo correlación entre la ocupación y la actividad de la empresa, por lo que se analizaron las EEPP según estas variables por separado. Por ocupación, los hombres presentaron un RR crudo de 1,067 (IC95%:1,058-1,076) frente a las mujeres, mientras que al ajustar por todas las variables del modelo el RR fue de 0,507 (IC95%:0,502-0,512). Por actividad, el sentido del riesgo también se invirtió en el análisis ajustado para el sexo (RRc=1,065, IC95%:1,056-1,074 frente a 0,632, IC95%:0,626-0,638). CONCLUSIONES: La declaración de EEPP durante el periodo 1999-2009 fue diferente entre hombres y mujeres según ocupación o actividad de la empresa.

Reconocimiento de enfermedades profesionales según sexo, ocupación y actividad de la empresa en España (1999-2009) / Differences in the recognition of occupational disease by sex, occupation and business activity in Spain (1990-2009)

Fundamentos: Según las estadísticas oficiales, los hombres sufren más enfermedades profesionales (EEPP) que las mujeres. No obstante, hay que tener presente su desigual distribución y participación en el mundo laboral. El objetivo de este estudio fue valorar cómo afecta el sexo al reconocimiento de EEPP en España, identificando posibles factores de interacción/confusión. Métodos: Se estudió la incidencia de las EEPP declaradas a través del Parte Oficial durante el período de 1999 al 2009, proporcionados por la Subdirección General de Estadísticas Sociales y Laborales del Ministerio de Empleo y Seguridad Social. Las variables incluidas fueron: año de declaración, sexo, edad, ocupación y actividad económica de la empresa. Se calcularon tasas y riesgos relativos (RR) crudos de EEPP por cada variable. Se estimaron los RR ajustados mediante análisis bivariable y multivariante de Poisson. Resultados: Durante 1999-2009 se notificaron en España 243.310 EEPP, con una razón de tasas hombres/mujeres de 1,07. Hubo correlación entre la ocupación y la actividad de la empresa, por lo que se analizaron las EEPP según estas variables por separado. Por ocupación, los hombres presentaron un RR crudo de 1,067 (IC95%:1,058-1,076) frente a las mujeres, mientras que al ajustar por todas las variables del modelo el RR fue de 0,507 (IC95%:0,502-0,512). Por actividad, el sentido del riesgo también se invirtió en el análisis ajustado para el sexo (RRc=1,065, IC95%:1,056-1,074 frente a 0,632, IC95%:0,626-0,638). Conclusiones: Aunque las tasas crudas de EEPP son inferiores en mujeres que en hombres durante el periodo 1999-2009 en España, al ajustar estas tasas por la actividad de la empresa o la ocupación del trabajador, la edad y el año de declaración, los RR pasan a ser casi un 50% superiores en mujeres que en hombres para la mayoría de ocupaciones y tipos de actividad de la empresa (AU)

Background: According to official statistics, men suffer more occupational diseases (OD) than women. Nevertheless, the unequal distribution and participation in the labor markets between men and women should be kept in mind. The aim was to assess the gender impact in the recognition of OD in Spain, examining interaction and confounding factors. Methods: An incidence study of the occupational diseases declared through the official OD reporting forms from 1999 to 2009, provided by the General Subdirectorate of Social and Labor Statistics of the Ministry of Employment and Social Security, was conducted. The variables included were: reporting year, sex, age, occupation and economic activity of the company. Rates and crude relative risks (cRR) by these variables were calculated. Adjusted RR were also computed by using multivariate Poisson regression. Results: During the study period a total of 243,310 OD were reported in Spain, with a sex ratio of men to women of 1.07. Correlation existed between occupation and business activity, thus the OD rates and RR were computed by these variables separately. By occupation, men had a crude RR of 1.067 (95%CI:1.058 to 1.076) versus women, while wen the analysis was adjusted by all the variables, the RR was 0.507 (95%CI:0.502 to 0.512). By economic activity of the company, the sense of risk was reversed too in the adjusted analysis (cRR=1.065, 95%CI:1.056 to 1.074 versus 0.632, 95%CI:0.626 to 0.638). Conclusions: Although crude OD rates are lower in women than in men during the period 1999-2009 in Spain, when these rates are adjusted by company activity or worker occupation, age and year of OD declaration, RRs become almost 50% higher in women than in men for the majority of occupations and types of company activity (AU)

Emergencias de salud pública de importancia internacional. Una oportunidad para mejorar la seguridad sanitaria global / Public Health Emergencies of International Concern. An opportunity to improve global health security

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[Possible introduction and autochthonous transmission of dengue virus in Spain]. / Posibilidad de introducción y circulación del virus del Dengue en España.

Dengue has become a major public health problem worldwide. Ae. albopictus, vector responsible for transmission, was first detected in Catalonia in 2004. Since then, it has established along Mediterranean coast. The aim of this paper is to describe the risk of importation and possible autochthonous transmission of dengue virus in Spain, qualitatively reviewing factors that could influence the emergence of dengue in our country, and the implications for public health. No autochthonous transmission has occurred in our country to date, but infected travelers coming from endemic countries are arriving to Spain constantly. The transmission of this disease could occur on the Mediterranean coast. Transmission would be more likely in the warmer months due to cultural habits and higher vector densities. While most of the population would be susceptible, given the characteristics of the disease, the impact on health's population would be low. The main public health strategy to reduce the risk of importation and possible dengue transmission should focus on primary prevention, to prevent interaction of the virus, vector and human. These three components must be addressed in a comprehensive and multisectoral plan of action, intensifying some activities in the areas of greatest risk. Coordination of public health from all sectors involved is essential for the proper functioning of this integrated response plan for vector-borne diseases.

Posibilidad de introducción y circulación del virus del Dengue en España / Possible introduction and autochthonous transmission of Dengue virus in Spain

El dengue se ha convertido en un importante problema de salud pública mundial. Ae. albopictus, vector competente para su transmisión, se detectó por primera vez en Cataluña en 2004. Desde entonces se ha establecido por la costa Mediterránea. El objetivo del artículo es describir el riesgo de importación y posible transmisión del dengue en España, revisando cualitativamente los factores que podrían influir en su emergencia en nuestro país, así como las implicaciones que tendría a nivel de salud pública. Aunque el virus no circula actualmente en España, constantemente llegan personas infectadas procedentes de países endémicos. La transmisión de esta enfermedad podría ocurrir en la costa mediterránea. Sería más probable en los meses más cálidos por los hábitos socioculturales y las mayor presencia del vector.Aunque la mayoría de la población es susceptible, el impacto en la salud de la población sería bajo dadas las características de la enfermedad. La estrategia fundamental de salud pública para reducir el riesgo de importación y posible transmisión del dengue debe enfocarse a la prevención primaria para evitar la interacción del virus, el vector y los seres humanos. Estos tres componentes deben abordarse dentro de un plan de acción integral y multisectorial, intensificando algunas actividades en las zonas de mayor riesgo. La coordinación desde salud pública de todos los sectores implicados es imprescindible para el correcto funcionamiento de este plan integral de respuesta ante enfermedades transmitidas por vectores (AU)

Dengue has become a major public health problem worldwide. Ae. albopictus, vector responsible for transmission, was first detected in Catalonia in 2004. Since then, it has established along Mediterranean coast. The aim of this paper is to describe the risk of importation and possible autochthonous transmission of dengue virus in Spain, qualitatively reviewing factors that could influence the emergence of dengue in our country, and the implications for public health. No autochthonous transmission has occurred in our country to date, but infected travelers coming from endemic countries are arriving to Spain constantly. The transmission of this disease could occur on the Mediterranean coast. Transmission would be more likely in the warmer months due to cultural habits and higher vector densities. While most of the population would be susceptible, given the characteristics of the disease, the impact on health’s population would be low. The main public health strategy to reduce the risk of importation and possible dengue transmission should focus on primary prevention, to prevent interaction of the virus, vector and human. These three components must be addressed in a comprehensive and multisectoral plan of action, intensifying some activities in the areas of greatest risk. Coordination of public health from all sectors involved is essential for the proper functioning of this integrated response plan for vector-borne diseases (AU)

Dispersion of Aedes albopictus in the Spanish Mediterranean Area.

Emergence and re-emergence of arboviral disease in new areas of southern Europe is becoming a public health problem. Since Aedes albopictus was first detected in 2004 in Catalonia, it has spread along the Spanish Mediterranean coast. Results of an entomological surveillance carried out by the Spanish Ministry of Health to monitor the expansion of Ae. albopictus along the Spanish Mediterranean coast between 2009 and 2012 are presented. Besides the new locations in Valencia and Murcia regional communities, it was identified in five municipalities in the Balearic Islands in 2012. A comprehensive plan aiming the control of invasive vector-borne diseases including entomological surveillance should be considered.

Excesos de mortalidad en España durante la transmisión de gripe pandémica en el año 2009 / Excess mortality in Spain during transmission of pandemic influenza in 2009

Fundamento: El sistema español de monitorización de la mor-talidad y el «Programa Europeo de monitorización de excesos de mortalidad para la acción en salud pública» detectaron dos excesos de mortalidad en España en noviembre y diciembre de 2009. El obje-tivo de este trabajo es valorar su posible asociación con la transmi-sión de gripe pandémica. Métodos: Se analizó la evolución de la mortalidad en España en los meses citados utilizando métodos de análisis de series temporales basados en las series históricas de mortalidad y se comparó en el tiempo con la transmisión de gripe. Resultados: La mortalidad observada en la población total fue mayor de lo esperado en dos periodos: semanas 46-47/2009 con 5,75% de exceso y las semanas 51-52/2009 con 7,35% de exceso. También se registró un exceso de mortalidad en niños de 5 a 14 años en las semanas 46-48/2009 con 41 defunciones vs las 21 esperadas. El exceso de mortalidad en noviembre fue concomitante con las mayores tasas de gripe. El exceso de diciembre se observó 5 semanas después del pico de gripe y coincidió con un descenso dramático de las temperaturas. El virus sincitial respiratorio y los accidentes de tráfico fueron descartados como factores asociados. Conclusiones: Mientras que las temperaturas podrían explicar la mayoría del exceso de mortalidad observado en diciembre, ningún factor por si solo podría explicar el exceso de noviembre(AU)

Background: The Spanish daily mortality monitoring system and the program «European monitoring of excess mortality for public health action» found two excesses of mortality in Spain in November and December 2009. Methods: We analyzed the evolution of mortality in Spain during those months using time-series analysis methods based on historical mortality series and compared it in the time with influenza transmission. Results: Observed mortality for the total population was higher than expected in two periods: weeks 46-47/2009 with 5.75% excess and weeks 51-52/2009 with 7.35% excess. Observed mortality hig-her than expected, was also observed in children 5-14 years old during weeks 46-48/2009 with 41 deaths vs 21 expected. Exces mor-tality in November occurred before or was concomitant with highest influenza incidence rates. Excess mortality in December occurred five weeks after the influenza incidence peak and along with drama-tic drop in temperatures. RSV and traffic accidents were ruled out as factor associated to these excesses. Conclusions: While temperatures could explain most of the excess mortality observed in December, no single factor could be associated with observed excess mortality in November(AU)

[Excess mortality in Spain during transmission of pandemic influenza in 2009]. / Excesos de mortalidad en España durante la transmisión de gripe pandémica en el año 2009.

BACKGROUND: The Spanish daily mortality monitoring system and the program «European monitoring of excess mortality for public health action¼ found two excesses of mortality in Spain in November and December 2009. METHODS: We analyzed the evolution of mortality in Spain during those months using time-series analysis methods based on historical mortality series and compared it in the time with influenza transmission. RESULTS: Observed mortality for the total population was higher than expected in two periods: weeks 46-47/2009 with 5.75% excess and weeks 51-52/2009 with 7.35% excess. Observed mortality higher than expected, was also observed in children 5-14 years old during weeks 46-48/2009 with 41 deaths vs 21 expected. Exces mortality in November occurred before or was concomitant with highest influenza incidence rates. Excess mortality in December occurred five weeks after the influenza incidence peak and along with dramatic drop in temperatures. RSV and traffic accidents were ruled out as factor associated to these excesses. CONCLUSIONS: While temperatures could explain most of the excess mortality observed in December, no single factor could be associated with observed excess mortality in November.