Monkeypox outbreak predominantly affecting men who have sex with men, Madrid, Spain, 26 April to 16 June 2022.

Up to 22 June 2022, 508 confirmed cases of monkeypox (MPX) have been reported in the Madrid region of Spain, 99% are men (n = 503) with a median age of 35 years (range: 18-67). In this ongoing outbreak, 427 cases (84.1%) reported condomless sex or sex with multiple partners within the 21 days before onset of symptoms, who were predominantly men who have sex with men (MSM) (n = 397; 93%). Both the location of the rash, mainly in the anogenital and perineal area, as well as the presence of inguinal lymphadenopathy suggest that close physical contact during sexual activity played a key role in transmission. Several cases reported being at a sauna in the city of Madrid (n = 34) or a mass event held on the Spanish island of Gran Canaria (n = 27), activities which may represent a conducive environment for MPX virus spread, with many private parties also playing an important role. Because of the rapid implementation of MPX surveillance in Madrid, one of the largest outbreaks reported outside Africa was identified. To minimise transmission, we continue to actively work with LGBTIQ+ groups and associations, with the aim of raising awareness among people at risk and encouraging them to adopt preventive measures.

[Outbreak of Trichophyton tonsurans ringworm in a health area of the Community of Madrid (Spain)]. / Epidemia de tiña por Trichophyton tonsurans en un área sanitaria de la Comunidad de Madrid (España).

BACKGROUND: Trichophyton tonsurans is a dermatophyte fungus that can cause ringworm outbreaks. In our health area in September 2013, two cases of T. tonsurans ringworm were diagnosed in children who lived in a Children's Centre. AIMS: To determine the origin and extent of the outbreak. METHODS: Mycological cultures of scalp and skin samples from the contacts of the diagnosed cases were performed, as well as environmental samples from the Children's Centre. The patients started with a treatment for their ringworm, and an environmental disinfection of the centre was performed. RESULTS: Twelve cases of ringworm were detected, along with three asymptomatic scalp carriers of T. tonsurans among 20 children in the Centre. The index case was a resident in whose family, that had just returned from their country of origin, Nigeria, three cases of ringworm were diagnosed. From November 2013 to February 2014 another five cases of ringworm were diagnosed among schoolmates of three cases from the Children's Centre. CONCLUSIONS: The antifungal treatment of the children resulted in the mycological and clinical resolution, and from February to November 2014 no other cases of ringworm by T. tonsurans in the same health area were diagnosed.

[Outbreak of Legionnaires' disease in a restaurant in the Community of Madrid, Spain]. / Brote de legionelosis en un restaurante de la Comunidad de Madrid.

BACKGROUND: on June 27, 2012, 46 cases of community- acquired Legionnaires'disease were detected in the Public Health Service area 8 of the Community of Madrid. All of them had been in the same restaurant of the city of Móstoles within the incubation period of the disease. METHODS: this is a descriptive study. Variables studied in the patients were: demographic data, medical history, symptoms, clinical course and diagnostic tests. For qualitative variables, frequencies and percentages were calculated. For quantitative variables, mínimum, máximum and average of values were calculated. In water samples taken on risk devices, we studied chlorine concentration, pH, temperatura and presence of Legionella. RESULTS: Legionella pneumophila Serogrupo 1, Subgrupo Pontiac Allentown/France was isolated from the water culture from the sand filter of the outside fountain's treatment plant; this result coincided with the strain isolated from respiratory samples of 4 patients. On the other hand, in biofilm samples obtained from the champagne bucket it was detected by PCR the presence of Legionella pneumophila whose gene sequencing was identical to that found in a respiratory sample of one patient. CONCLUSION: Legionella pneumophila serogroup 1 subgroup Pontiac Allentown/France serotype 448 was isolated in water samples, and this Legionella coincided with the one isolated from respiratory samples of some patients. So, we could show the link between environmental risk factor and the disease. This link was also confirmed by genetic sequencing with PCR.

Epidemia de tiña por Trichophyton tonsurans en un área sanitaria de la Comunidad de Madrid (España) / Outbreak of Trichophyton tonsurans ringworm in a health area of the Community of Madrid (Spain)

Antecedentes. Trichophyton tonsurans es un hongo dermatofito que puede dar lugar a epidemias de tiña. En septiembre de 2013 fueron diagnosticados en nuestra área sanitaria dos casos de tiña por T. tonsurans en niños que convivían en un centro infantil. Objetivos. Conocer el origen y la extensión del brote. Métodos. Se realizaron cultivos micológicos de muestras de cuero cabelludo y piel de los contactos de los casos detectados, y de muestras ambientales del centro infantil. Se inició el tratamiento de los pacientes y la desinfección ambiental del centro. Resultados. Se identificaron doce casos de tiña y tres portadores asintomáticos de T. tonsurans en el cuero cabelludo entre los 20 menores residentes del centro infantil. El caso índice fue un residente del centro en cuya familia, que acababa de regresar de su país de origen, Nigeria, se detectaron tres casos de tiña. Desde noviembre de 2013 a febrero de 2014 se diagnosticaron otros cinco casos de tiña en compañeros de colegio de tres casos del centro infantil. Conclusiones. El tratamiento resolvió clínica y micológicamente los casos, y entre marzo y noviembre de 2014 no se diagnosticó ningún otro caso de tiña por T. tonsurans en la misma área sanitaria (AU)

Background. Trichophyton tonsurans is a dermatophyte fungus that can cause ringworm outbreaks. In our health area in September 2013, two cases of T. tonsurans ringworm were diagnosed in children who lived in a Children's Centre. Aims. To determine the origin and extent of the outbreak. Methods. Mycological cultures of scalp and skin samples from the contacts of the diagnosed cases were performed, as well as environmental samples from the Children's Centre. The patients started with a treatment for their ringworm, and an environmental disinfection of the centre was performed. Results. Twelve cases of ringworm were detected, along with three asymptomatic scalp carriers of T. tonsurans among 20 children in the Centre. The index case was a resident in whose family, that had just returned from their country of origin, Nigeria, three cases of ringworm were diagnosed. From November 2013 to February 2014 another five cases of ringworm were diagnosed among schoolmates of three cases from the Children's Centre. Conclusions. The antifungal treatment of the children resulted in the mycological and clinical resolution, and from February to November 2014 no other cases of ringworm by T. tonsurans in the same health area were diagnosed (AU)

Brote de Legionelosis en un restaurante de la Comunidad de Madrid / Outbreak of legionnaires' disease in a restaurant in the Community of Madrid, Spain

Fundamentos: el 27 de Junio de 2012 se detectó en el Servicio de Salud Pública del Área 8 de la Comunidad de Madrid un brote de legionelosis con 46 personas afectadas. Todas habían estado en el mismo restaurante del municipio deMóstoles dentro del periodo de incubación de la enfermedad. El objetivo de este trabajo es describir la evolución del brote y las medidas sanitarias adoptadas durante el mismo. Métodos: se trata de un estudio descriptivo. Se estudiaron las variables demográficas de los enfermos , antecedentes patológicos, síntomas, evolución clínica y pruebas diagnósticas. Para las variables cualitativas se calcularon frecuencias y porcentajes. Para las variables cuantitativas la media, el valor mínimo y máximo. En las muestras de agua tomadas en las instalaciones de riesgo se estudió concentración de cloro, pH, temperatura y presencia de Legionella. Resultados: en el cultivo del agua del filtro de arena de la depuradora de la fuente exterior creció Legionella pneumophila Serogrupo 1, Subgrupo PontiacAllentown/France. Este resultado coincidió con la cepa aislada en las muestras respiratorias de 4 pacientes. Por otro lado, en las muestras de biopelícula obtenidas en la champanera se detectó por PCR la presencia de Legionella pneumophila cuya secuenciación de genes fue idéntica a la encontrada en la muestra respiratoria de un paciente. Conclusiones: se consiguió aislar Legionella pneumophila serogrupo 1 Subgrupo Pontiac Allentown/France serotipo 448 en muestras ambientales, coincidente con la Legionella aislada en muestras respiratorias de algunos pacientes, por lo que se pudo demostrar la vinculación entre el factor de riesgo ambiental y la enfermedad. Este vínculo se confirmó además por secuenciación genética realizada por PCR (AU)

Background: on June 27, 2012, 46 cases of community- acquired Legionnaires' disease were detected in the Public Health Service area 8 of the Community of Madrid.All of them had been in the same restaurant of the city of Móstoles within the incubation period of the disease. Methods: this is a descriptive study. Variables studied in the patients were: demographic data, medical history, symptoms, clinical course and diagnostic tests. For qualitative variables, frequencies and percentages were calculated. For quantitative variables, mínimum, máximum and average of values were calculated. In water samples taken on risk devices, we studied chlorine concentration, pH, temperatura and presence of Legionella. Results: Legionella pneumophila Serogrupo 1, Subgrupo Pontiac Allentown/France was isolated from the water culture from the sand filter of the outside fountain' s treatment plant; this result coincided with the strain isolated from respiratory samples of 4 patients. On the other hand, in biofilm samples obtained from the champagne bucket it was detected by PCR the presence of Legionella pneumophila whose gene sequencing was identical to that found in a respiratory sample of one patient. Conclusion: Legionella pneumophila serogroup 1 subgroup Pontiac Allentown/France serotype 448 was isolated in water samples, and this Legionella coincided with the one isolated from respiratory samples of some patients. So, we could show the link between environmental risk factor and the disease. This link was also confirmed by genetic sequencing with PCR (AU)

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