What risk do Brucella vaccines pose to humans? A systematic review of the scientific literature on occupational exposure.

BACKGROUND: Currently, vaccination of livestock with attenuated strains of Brucella remains an essential measure for controlling brucellosis, although these vaccines may be dangerous to humans. The aim of this study was to review the risk posed to humans by occupational exposure to vaccine strains and the measures that should be implemented to minimize this risk. METHODS: This article reviewed the scientific literature indexed in PubMed up to September 30, 2023, following "the PRISMA guidelines". Special emphasis was placed on the vaccine strain used and the route of exposure. Non-occupational exposure to vaccine strains, intentional human inoculation, publications on exposure to wild strains, and secondary scientific sources were excluded from the study. RESULTS: Nineteen primary reports were found and classified in three subgroups: safety accidents in vaccine factories that led to an outbreak (n = 2), survellaince studies on vaccine manufacturing workers with a serologic diagnosis of Brucella infection (n = 3), and publications of infection by vaccine strains during their administration, including case reports, records of occupational accidents and investigations of outbreaks in vaccination campaigns (n = 14). Although accidental exposure during vaccine manufacturing were uncommon, they could provoke large outbreaks through airborne spread with risk of spread to the neighboring population. Besides, despite strict protection measures, a percentage of vaccine manufacturing workers developed positive Brucella serology without clinical infection. The most frequent type of exposure with symptomatic infection was needle injury during vaccine administration. Prolonged contact with the pathogen, lack of information and a low adherence to personal protective equipment (PPE) use in the work environment were commonly associated with infection. CONCLUSIONS: Brucella vaccines pose occupational risk of contagion to humans from their production to their administration to livestock, although morbidity is low and deaths were not reported. Recommended protective measures and active surveillance of exposed workers appeared to reduce this risk. It would be advisable to carry out observational studies and/or systematic registries using solid diagnostic criteria.

Varón de 48 años con inflamación subcutánea y eosinofilia / No disponible

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Vertebral osteomyelitis: long-term disability assessment and prognostic factors.

In the present study, we quantified the long-term sequelae of a series of patients diagnosed with vertebral osteomyelitis during the period 1990-2002 in Albacete (Spain), using two validated questionnaires of spinal dysfunction and also one pain and one global health assessment. It was possible to interview 69 (78%) patients diagnosed with vertebral osteomyelitis, and an additional 90 "normal" people were recruited as controls to establish normal values. We also carried out a multivariate analysis to identify independent risk factors. We found only a 33% rate of spinal disability, only 3% severe, assessed by the Oswestry and HAQ for ankylosing spondylitis questionnaires, a median of 5.4 years after treatment. Pain and global health assessment did not correlate with spinal function questionnaires. Independent predictors of long-term disability were the followings: neurological impairment at the time of diagnosis (RR=7.1, 95% CI 1.3-10.2), time to diagnosis > or = 8 weeks (RR=4.4, 95% CI 1.5-7.9) and debilitating disease (RR=3.9, 95% CI 1.2-7.5). Standardized spinal function questionnaires are useful measures to assess long-term outcome of vertebral osteomyelitis that facilitates comparison between case series and identification of risk factors.

[Incidence of infectious spondylitis in the province of Albacete (Spain)]. / Incidencia de la espondilitis infecciosa en la provincia de Albacete.

BACKGROUND: Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published. OBJECTIVES: To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area. METHODS: We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data. RESULTS: The incidence of IS was 2.40 cases/10(5) inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10(5) inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10(5) inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10(5) inhabitants/year and its frequency increased with age. CONCLUSION: The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles.

Incidencia de la espondilitis infecciosa en la provincia de Albacete / Incidence of infectious spondylitis in the province of Albacete (Spain)

Antecedentes. La espondilitis infecciosa es una enfermedad infrecuente, aunque existen pocos datos sobre su incidencia real. Hasta la fecha, sólo se ha publicado un estudio, realizado en Dinamarca, que valora de forma rigurosa su incidencia. Objetivos. Conocer la incidencia de espondilitis infecciosa en la población no pediátrica de la provincia de Albacete, así como el comportamiento por etiologías, grupos de edad y sexo y zonas geográficas. Métodos. Búsqueda retrospectiva de todos los casos diagnosticados de espondilitis infecciosa en la provincia de Albacete durante el período 1990-2002, calculando las tasas de incidencia ajustadas, a partir de los datos censales. Resultados. La incidencia de espondilitis infecciosa fue de 2,40 casos/10 5 habitantes/año. La incidencia de la espondilitis infecciosa brucelar fue 1,18 casos/10 5 habitantes/año, con predominio en la zona rural y en varones y con una distribución por edad bimodal (con un primer pico de incidencia alrededor de los 40 años y un segundo a los 60 años). Su incidencia se ha reducido de forma importante en los últimos años. La espondilitis infecciosa piógena (incidencia de 0,64 casos/10 5 habitantes/año) mostró un pico de incidencia alrededor de los 60 años y un comportamiento por sexo y por zonas geográficas mucho más uniforme. La espondilitis infecciosa tuberculosa tuvo una incidencia de 0,45 casos/10 5 habitantes/año y su frecuencia aumentó con la edad. Conclusión. Se obtuvieron tasas de incidencia superiores a la mayoría de los estudios previos y sólo comparables a los estudios más rigurosos, lo que sugiere que la incidencia de espondilitis infecciosa puede haber sido subestimada. Los tres grupos etiológicos del estudio mostraron un comportamiento epidemiológico distinto (AU)

Background. Infectious spondylitis (IS) is an infrequent disease, although there are few data on its real incidence. To date, only one study, carried out in Denmark, that rigorously assesses the incidence of this disease has been published. Objectives. To determine the incidence of IS in the nonpediatric population of the province of Albacete, and to analyze differences according to etiology, age, sex, and geographical area. Methods. We carried out a retrospective search of all the IS cases diagnosed in the province of Albacete during the period 1990-2002 and calculated the adjusted incidence rates using census data.Results. The incidence of IS was 2.40 cases/10 5 inhabitants/year. Brucellar spondylitis had an incidence of 1.18 cases/10 5 inhabitants/year, with a predominance in the rural area and in men. Distribution by age was bimodal, with a first peak around 40 years old and a second peak around 60 years old. The incidence has significantly decreased in the last few years. Pyogenic spondylitis (incidence of 0.64 cases/10 5 inhabitants/year) showed a maximum incidence at around 60 years old, while its distribution by sex and geographical area was more uniform. Tuberculous spondylitis had an incidence of 0.45 cases/10 5 inhabitants/year and its frequency increased with age. Conclusion. The incidence rates of IS were higher than those reported in most previous studies, although they were similar to those observed in the most rigorous reports. These findings suggest that the frequency of IS could have been underestimated. The three etiologic groups analyzed showed distinct epidemiological profiles (AU)

Peritonitis bacteriana espontánea por Hafnia alvei / Spontaneous bacterial peritonitis due to Hafnia alvei

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