[Excess mortality associated with influenza in Spain in winter 2012]. / Exceso de mortalidad relacionado con la gripe en España en el invierno de 2012.

OBJECTIVE: An excess of mortality was detected in Spain in February and March 2012 by the Spanish daily mortality surveillance system and the «European monitoring of excess mortality for public health action¼ program. The objective of this article was to determine whether this excess could be attributed to influenza in this period. METHODS: Excess mortality from all causes from 2006 to 2012 were studied using time series in the Spanish daily mortality surveillance system, and Poisson regression in the European mortality surveillance system, as well as the FluMOMO model, which estimates the mortality attributable to influenza. Excess mortality due to influenza and pneumonia attributable to influenza were studied by a modification of the Serfling model. To detect the periods of excess, we compared observed and expected mortality. RESULTS: In February and March 2012, both the Spanish daily mortality surveillance system and the European mortality surveillance system detected a mortality excess of 8,110 and 10,872 deaths (mortality ratio (MR): 1.22 (95% CI:1.21-1.23) and 1.32 (95% CI: 1.29-1.31), respectively). In the 2011-12 season, the FluMOMO model identified the maximum percentage (97%) of deaths attributable to influenza in people older than 64 years with respect to the mortality total associated with influenza (13,822 deaths). The rate of excess mortality due to influenza and pneumonia and respiratory causes in people older than 64 years, obtained by the Serfling model, also reached a peak in the 2011-2012 season: 18.07 and 77.20, deaths per 100,000 inhabitants, respectively. CONCLUSION: A significant increase in mortality in elderly people in Spain was detected by the Spanish daily mortality surveillance system and by the European mortality surveillance system in the winter of 2012, coinciding with a late influenza season, with a predominance of the A(H3N2) virus, and a cold wave in Spain. This study suggests that influenza could have been one of the main factors contributing to the mortality excess observed in the winter of 2012 in Spain.

Assessment of tuberculosis surveillance by capture-recapture in the Balearic Islands, Spain, 2005-2007.

The tuberculosis surveillance system in the Balearic Islands was assessed from 2005 to 2007. Applying the capture-recapture method the completeness of this system was evaluated to be 58.4%. When a new electronic recorded data was included in Primary Health Care, up to 66.5% was obtained. This new source of data increased the detected cases of pulmonary tuberculosis from 572 to 681. As a result, the estimated annual incidence rate increases from 18.9 cases/10(5) to 22.6 cases/10(5) [95% CI, 20.9-24.3], similar to figures issued by WHO.

[Premature mortality excess related to influenza in Spain during an interpandemic period]. / Exceso de mortalidad precoz relacionado con la gripe en España durante un período interpandémico.

BACKGROUND: The indicator of Potential Years of Life Lost (PYLL) has been frequently used to analysis of premature mortality and recently has been used to estimate the impact of the last influenza A(H1N1)pdm09 pandemic. The aim of this study was to estimate the excess deaths from pneumonia and influenza (P&I) in Spain and the PYLL during the period 1980-2008, measuring the mortality attributable to influenza regarding the type/subtype of influenza dominant in each season. METHODS: Monthly excess deaths were calculated with cyclical regression models. The PYLL calculation was performed as the product of the number of excess deaths and the difference between life expectancy at birth and years lived for each age group. The analysis of the variation between P&I excess deaths and PYLL, depending on the predominant influenza virus type/subtype was carried out with a Poisson regression analysis. RESULTS: In seasons dominated by influenza virus A(H3) the average P&I excess deaths was estimated at 1,348, and for PYLL in 5.297, while in seasons dominated by A(H1) or B the average P&I excess deaths was 648, and for PYLL 2.885. The adjusted rate ratios of excess (2.11, CI-95%=2.05-2.16) and PYLL (1.86, CI-95%=1.83-1.88) indicate that the relative frequencies for both indicators are significantly larger in seasons dominated by influenza virus A(H3). CONCLUSIONS: Excess deaths and PYLL doubled when comparing seasons predominantly subtype A(H3) and other influenza viruses.

[Transmissibility and severity of the pandemic influenza A (H1N1) 2009 virus in Spain]. / Transmisibilidad y gravedad de la pandemia de gripe A(H1N1)2009 en España.

OBJECTIVES: To estimate the value of the basic reproduction number for the pandemic wave of influenza A (H1N1) 2009 in Spain and to assess its impact on morbidity and mortality in the Spanish population compared with those in the previous influenza season. METHODS: Data on the incidence of influenza and viral detections were obtained from the Spanish Influenza Surveillance System. Deaths from pandemic influenza were obtained from the Coordinating Center for Health Alerts and Emergencies of the Spanish Ministry of Health and Social Policy, and deaths from seasonal influenza during the period 2003-2008 were obtained from the National Statistics Institute. The reproduction number was estimated by two methods: firstly, by using the growth rate of the cumulative incidence of influenza during the exponential growth phase of the pandemic wave, and secondly (maximum likelihood estimation), through analysis the dates of onset of symptoms observed in pairs of cases based on generation time distribution. We calculated the fatality rate and mortality from influenza by comparing potential years of life lost in the pandemic season with those in previous interpandemic seasons. RESULTS: The start of the pandemic wave occurred in Spain earlier in week 40/2009 (from 4 to 10 October), with an absolute predominance of the new strain in the pattern of circulating viruses. The value of R(0) in the growth phase of the wave was 1.29 (95% CI: 1.25-1.33), estimated with the first method, and was 1.01 (95% CI: 0.99-1.03) with the second method. During the pandemic season, there were 318 deaths from pandemic influenza, affecting younger age groups than in previous interpandemic seasons. Consequently, the number of potential years of life lost in the pandemic season (11,612) was estimated at six times the adjusted annual average of the interpandemic influenza seasons for comparison (1,802). CONCLUSIONS: The estimates of R(0) for the growth phase of the pandemic wave were in the lower range of estimates of this parameter in previous pandemics. Mortality indicators calculated in the pandemic period showed an increase in deaths compared with previous interpandemic seasons, which was most pronounced in young patients.

[Surveillance of influenza pandemic (H1N1)2009 in Spain]. / Vigilancia de la pandemia de gripe (H1N1) 2009 en España.

BACKGROUND: During the summer of 2009, Spain experienced the circulation of the novel influenza (H1N1)2009 virus, beyond the usual period of influenza activity, increasingly evolving up to the presentation in the early autumn of the first wave of the pandemic virus. The objectives of this study are to describe the evolution of the pandemic wave in our country and to assess their impact on morbidity and mortality of the Spanish population. METHOD: From the information obtained from the Spanish Influenza Surveillance System and the Coordinating Centre for Health Alerts and Emergencies within Spanish Ministry of Health and Social Policy have been estimated a number of epidemiological and virological indicators that were used to assess the level of activity and intensity of the pandemic wave, as well as its severity RESULTS: The beginning of the pandemic wave in Spain started in early autumn 2009 reaching the maximum weekly incidence rate of 372.15 cases/100,000 inhabitants. The highest incidence was registered in under 15 years old. Viral detection rate registered during the pandemic period remained at the range of previously recorded (46.4%). We estimated an overall mortality rate of 0.43 deaths per 1,000 pandemic cases. The 64% of deaths from pandemic influenza occurred in young adults and the highest mortality rates were registered in the 45-64 years age group with 9.35 deaths/1,000,000 inhabitants. Mortality associated with seasonal influenza in the period 2001-2008 was highest in those over 64 years (95% of all deaths). CONCLUSIONS: The influenza (H1N1)2009 pandemic wave in Spain showed an early presentation and a medium level of influenza intensity compared to the previous thirteen seasonal influenza waves. Considering lethality or mortality rates, this first pandemic wave was also characterized by a mild severity, although a high percentage of deaths confirmed by the new virus were observed in population under 65 years.

[The Spanish Epidemological Surveillance Services webpages as an information dissemination tool in 2006]. / Las páginas web de los servicios de vigilancia epidemiológica como instrumento de difusión de la información en 2006.

BACKGROUND: Taking into account that one of the Spanish National Epidemological Surveillance Network's missions is that of providing information for taking action, it is then absolutely essential that its information be disseminated in a timely manner. This study is aimed at ascertaining what information is being published on the National Epidemology Center webpages and on those of the Municipal and Autonomous Community Epidemiological Surveillance Services and assessing the timeliness of the information published. METHODS: A review was conducted of the contents of the Surveillance Services webpages of April 3 - May 5, 2006. The information was considered to be "timely" if the information read on the webpage during Week 17 provided the epidemological week 15 bulletin. RESULTS: A total of ninety percent (90%) of the Services have a webpage, fifty percent (50%) of which provide the listing of the compulsorily reportable disease and the case definition, a total of 44% having protocols for taking action and 11% having dynamic tables. The epidemological bulletins can be accessed via eight-three percent (83%) of the pages, six percent of which are updated in a timely manner. A total of seventy-seven (77%) of the pages provide weekly influenza information, seventy-eight percent (78%) in week 15. A total seventy-two percent (72%) have a search system as well as links to other Surveillance Services. CONCLUSIONS: The information provided by the Epidemological Surveillance Services has been found to vary to a certain degree. Influenza information is being disseminated in a timely manner, this however not being the case for the Epidemiological Bulletin.

[Nosocomial epidemic outbreak of acute gastroenteritis by Norwalk-like virus]. / Estudio de un brote epidémico nosocomial de gastroenteritis aguda por virus Norwalk-like.

BACKGROUND: From the notification of an acute gastroenteritis outbreak in a nursing home, an epidemiological study was started to determine the characteristics of the outbreak and its spreading pattern and to identify determining factors. PATIENTS AND METHOD: A study of historic cohorts was performed and the case was defined by the presence of diarrhea and vomiting. Spatial aggregation in double rooms was analyzed by a binomial distribution and temporal aggregation was analyzed by a relative risks model. The variables in the study allowed us to calculate the adjusted relative risk; the odds ratio was calculated in relation to the meal on day January 30. RESULTS: We studied 95.9% residents. The total attack rate was 28.7% (31.8% employees, 30.1% permanent residents and 15.2% day residents). The attack rate in rotation health personnel was 45.2%. Spatial and temporal spread in double rooms was negative. There was a significant association with the disease in rotator employees (RR = 3.22; CI 95%, 1.30-7.99; p = 0.02). No association was found between eating and disease (OR = 1.5; CI 95%, 0.4-6.1; p = 0.46). Norwalk-like virus was isolated in four faecal samples. CONCLUSIONS: This epidemic outbreak had the characteristic of a nosocomial infection with a likely person-to-person transmission mechanism. The main factor contributing to the spread of the infection was the existence of employees in permanent contact with residents with an important physical and mental impairment, hence highly dependent on the care provided by these health workers.