Crimean-Congo haemorrhagic fever (CCHF) virus-specific antibody detection in blood donors, Castile-León, Spain, 2017 and 2018.

BackgroundCrimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging or even a probable re-emerging pathogen in southern Europe. Presence of this virus had been reported previously in Spain in 2010.AimWe aimed to evaluate the potential circulation of CCHFV in western Spain with a serosurvey in asymptomatic adults (blood donors).MethodsDuring 2017 and 2018, we conducted a CCHFV serosurvey in randomly selected asymptomatic blood donors from western Spain. Three assays using specific IgG antibodies against CCHFV were performed: the VectoCrimea ELISA test, an in-house ELISA and indirect immunofluorescence (EuroImmun) test with glycoprotein and nucleoprotein.ResultsA total of 516 blood donors participated in this cross-sectional study. The majority of the study participants were male (68.4%), and the mean age was 46.3 years. Most of the participants came from rural areas (86.8%) and 68.6% had contact with animals and 20.9% had animal husbandry practices. One in five participants (109/516, 21.1%) were engaged in at-risk professional activities such as agriculture and shepherding, slaughtering, hunting, veterinary and healthcare work (mainly nursing staff and laboratory technicians). A total of 15.3% of the participants were bitten by ticks in the days or months before the date of sampling. We detected anti-CCHFV IgG antibodies with two diagnostic assays in three of the 516 individuals and with one diagnostic assay in six of the 516 individuals.ConclusionSeroprevalence of CCHFV was between 0.58% and 1.16% in Castile-León, Spain. This is the first study in western Spain that showed circulation of CCHFV in healthy people.

Health and wellbeing status of the long-lived individuals of the Spanish LONGECYL cross-sectional study.

BACKGROUND: The increase in life expectancy and long-lived individuals is a challenge for public health and provides an opportunity to understand the determinants of longevity. However, few studies have addressed the factors associated with the health status and quality of life in a long-lived individual population. We described the perceived health, clinical status, quality of life, and dependency for activities of daily living in a representative population in Castile and Leon, Spain. METHODS: A sample of 759 long-lived individuals aged 95 years and older was studied by the Health Sentinel Network of Castile and Leon (Spain) through a health examination and a structured questionnaire covering quality of life (EQ-5D-3), lifestyle habits, diet, working life and family health. A blood sample was taken for the study of biological and genetic markers. Chi Square and logistic regression OR with 95% confidence intervals were used to analyze the determinants of the long-lived individuals' health status. The significant level for the bivariate analysis was established at 0.05. RESULTS: Perceived health was good, very good or excellent in 64.2%, while only 46.0% had a quality-of-life index above 0.5 (ranging from 0 to 1) and 44.1% maintained acceptable independence for activities of daily living. Quality-of-life index was higher in the oldest, (OR 7.98 [2,32-27.41]) above 100 years compared to those under 98, and men had better values for independence than women (OR 2.43 [1.40-4.29]). Cardiovascular diseases were the most prevalent (85.5%), but neurological and mental diseases and vision problems had the highest impact on quality of life and independence. CONCLUSION: The long-lived individuals of Castile and Leon have a relatively well-preserved health status, although the perception of health is higher than that describing their quality of life and dependence. The quality of life was higher in the oldest age group and showed differences according to sex, with a better quality of life in men. Public health policies and programs should take in account the differences by sex and age as well as the prevention and control of the main conditions related with poor quality of life or dependence. Future research must include the interaction among genetic, socioeconomic, environmental, and other clinical factors in the quality of life and disability of long-lived individuals.

Identification and Distribution of Human-Biting Ticks in Northwestern Spain.

Ticks transmit a wide diversity of pathogens to a great variety of hosts, including humans. We conducted a tick surveillance study in northwestern Spain between 2014 and 2019. Ticks were removed from people and identified. Tick numbers, species, development stages, the timeline, seasonal and geographical distribution and epidemiological characteristics of people bitten by ticks were studied. We collected ticks from 8143 people. Nymphs of I. ricinus were the most frequently collected. Rhipicephalus bursa, R. sanguineus s.l., Hy. marginatum, Hy. lusitanicum, D. marginatus, D. reticulatus and H. punctata were also found, with adults as the main stage. The number of collected Hyalomma spp. and R. bursa has been progressively increasing over time. Although bites occurred throughout the year, the highest number of incidents was reported from April to July. The distribution patterns of the tick species were different between the north and the south of the region, which was related to cases detected in humans of the pathogens they carried. Adult men were more likely to be bitten by ticks than women. Ticks were most frequently removed from adults from the lower limbs, while for children, they were mainly attached to the head. Epidemiological surveillance is essential given the increase in tick populations in recent years, mainly of species potentially carrying pathogens causing emerging diseases in Spain, such as Crimean-Congo hemorrhagic fever (CCFH).

Applications of MALDI-TOF Mass Spectrometry to the Identification of Parasites and Arthropod Vectors of Human Diseases.

Arthropod vectors and parasites are identified morphologically or, more recently, by molecular methods. Both methods are time consuming and require expertise and, in the case of molecular methods, specific devices. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) identification of bacteria has meant a major change in clinical microbiology laboratories because of its simplicity, speed and specificity, and its capacity to identify microorganisms, in some cases, directly from the sample (urine cultures, blood cultures). Recently, MALDI-TOF MS has been shown as useful for the identification of some parasites. On the other hand, the identification of vector arthropods and the control of their populations is essential for the control of diseases transmitted by arthropods, and in this aspect, it is crucial to have fast, simple and reliable methods for their identification. Ticks are blood-sucking arthropods with a worldwide distribution, that behave as efficient vectors of a wide group of human and animal pathogens, including bacteria, protozoa, viruses, and even helminths. They are capable of parasitizing numerous species of mammals, birds and reptiles. They constitute the second group of vectors of human diseases, after mosquitoes. MALDI-TOF MS has been shown as useful for the identification of different tick species, such as Ixodes, Rhipicephalus and Amblyomma. Some studies even suggest the possibility of being able to determine, through MALDI-TOF MS, if the arthropod is a carrier of certain microorganisms. Regarding mosquitoes, the main group of vector arthropods, the possibility of using MALDI-TOF MS for the identification of different species of Aedes and Anopheles has also been demonstrated. In this review, we address the possibilities of this technology for the identification of parasites and arthropod vectors, its characteristics, advantages and possible limitations.

[Prevalence of hypertension in the population of Castile-Leon (Spain)]. / Prevalencia de la hipertensión arterial en la población de Castilla y León.

OBJECTIVE: Cardiovascular disease causes one out of 3 deaths in Spain. Hypertension is involved in ischemic heart disease and in other diseases provoking high morbidity and mortality. The aim of the present study was to describe the prevalence of hypertension and other indicators of this disorder in Castile-Leon in 2004. METHODS: We performed a cross-sectional study in a random sample of 4,012 persons aged 15 years old or above, extracted through a two-stage, stratified design. Systolic and diastolic blood pressure was measured, a history was taken and clinical records were reviewed. A person was considered to be hypertensive when there was known hypertension (hyper-tension was recorded in the clinical records or the person was receiving treatment for hypertension) or when systolic blood pressure was 140 mmHg or more and diastolic blood pressure was 90 mmHg or more. RESULTS: The prevalence of hypertension in the population was 38.7% (95%CI: 36.5-40.9). The prevalence was higher in men (40.4% [95%CI: 37.4-43.4]) than in women (37.4% [95%CI: 34.7-40]). Hypertension was already known in 22.2%, representing 57.4% of all hypertensive individuals. In the remainder of the sample, 44% had prehypertension, 17.5% had stage 1 hypertension and 4% had stage II hypertension, according to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. CONCLUSIONS: The prevalence of hypertension in the population studied was consistent with that reported in other Spanish studies. A substantial proportion of hypertensive individuals were unaware of their status as such. Equally, a large proportion had prehypertension, which carries a high risk of cardiovascular disease.

[Design of a population-based study of cardiovascular risk in Castile and Leon [Spain] through primary care teams]. / Diseño de un estudio poblacional del riesgo cardiovascular en Castilla y León a través de los equipos de atención primaria.

We describe the design and the response indicators in a cross sectional study to estimate several factors associated with cardiovascular risk in the population of Castile and Leon. A sample of 4,950 individuals aged 15 years and above was obtained in two stages: in the first stage, 198 primary care physicians were selected and in the second stage a sample of 25 persons from each primary care physician's list was obtained. The response rate was 98% among primary care physicians and 80% among the population. Statistically significant differences were found in age distribution between the frame sample and the definitive sample. After applying design adjustments, only the group aged 35-64 years was significantly overdimensioned. Access to the general population in primary health care is a feasible and effective procedure. A high response rate contributes to the validity of the information.

Spotted fever group rickettsiae in ticks feeding on humans in northwestern Spain: is Rickettsia conorii vanishing?

During a 7-year study, we identified and analyzed by PCR 4,049 ticks removed from 3,685 asymptomatic patients in Castilla y León (northwestern Spain). A total of 320 ticks (belonging to 10 species) were PCR-positive for rickettsiae. Comparison of amplicon sequences in databases enabled us to identify eight different spotted fever group (SFG) rickettsiae: Rickettsia slovaca, Rickettsia sp. IRS3/IRS4, R. massiliae/Bar29, R. aeschlimannii, Rickettsia sp. RpA4/DnS14, R. helvetica, Rickettsia sp. DmS1, and R. conorii. Although Mediterranean spotted fever (MSF) is an endemic disease in Castilla y León, R. conorii was found in only one Rhipicephalus sanguineus tick, whereas other pathogenic SFG rickettsiae were much more prevalent in the same area. Our data suggest that in Castilla y León, many MSF or MSF-like cases attributed to R. conorii could have been actually caused by other SFG rickettsiae present in ticks biting people in this region of Spain.

Cystic echinococcosis in Spain: current situation and relevance for other endemic areas in Europe.

Cystic echinococcosis (CE) remains an important health problem in many regions of the world, both where no control measures have been implemented, and where control programs have been incompletely successful with ensuing re-emergence of the disease. In Spain, official data on CE show an increase in the proportion of intermediate hosts with CE during the last few years, and autochthonous pediatric patients have been reported, a sign of active local transmission of disease. A similar picture emerges from data reported to the European Food Safety Authority by other European countries. Nevertheless, several crucial aspects related to CE that would help better understand and control the disease have not been tackled appropriately, in particular the emergence of infection in specific geographical areas. In this respect, while some data are missing, other data are conflicting because they come from different databases. We review the current situation of CE in Spain compared with areas in which similar problems in the CE field exist, and offer recommendations on how to overcome those limitations. Specifically, we believe that the introduction of national registries for CE with online data entry, following the example set by the European Registry for Alveolar Echinococcosis, would help streamline data collection on CE by eliminating the need for evaluating and integrating data from multiple regions, by avoiding duplication of data from patients who access several different health facilities over time, and by providing much needed clinical and epidemiological data that are currently accessible only to clinicians.

Obesity in Castile and Leon, Spain: epidemiology and association with other cardiovascular risk factors.

A cross-sectional study of obesity in a random sample of 4012 individuals aged ≥ 15 years in Castile and Leon, Spain, was carried out. The prevalence of obesity (i.e. a body mass index ≥ 30 kg/m²) and abdominal obesity (i.e. a waist circumference > 102 cm in males or > 88 cm in females) was determined and associations between both types of obesity and other cardiovascular risk factors were investigated. The overall prevalence of obesity was 21.7% (95% confidence interval [CI], 20.3%-23.2%): it was higher in women, at 23.2% (95% CI, 20.9%-25.5%), than in men, at 20.4% (95% CI, 18.0%-22.7%). The prevalence of abdominal obesity was 36.7% (95% CI, 34.6%-38.9%): again it was higher in women, at 50.1% (95% CI, 47%-53.1%) than in men, at 22.8% (95% CI, 20.3%-25.2%). Associations were found between obesity and all classic cardiovascular risk factors, except smoking. The 10-year Systematic Coronary Risk Evaluation (SCORE) and Framingham risk scores were higher in obese individuals.

[Dyslipidemia and cardiovascular risk in the adult population of Castile-Leon (Spain)]. / Dislipidemias y riesgo cardiovascular en la población adulta de Castilla y León.

OBJECTIVE: Hypercholesterolemia is one of the cardiovascular risk factors more sensitive to preventive and control interventions. This study aims to determine the epidemiological pattern of dyslipidemic people in Castilla y Leon. METHODS: A representative stratified two-stage sample of the population resident in Castilla y León (Spain) was obtained. A total of 4,013 people age 15 years and older were interviewed. Cardiovascular disease related variables were gathered from clinical records and medical examination. Total cholesterol, HDL-c, LDL-c, and triglycerides were measured. RESULTS: Total cholesterol, HDL-c, LDL-c and triglycerides increase with age and, all but total cholesterol present gender differences. LDL-c and triglycerides are higher in men than in women under the age of 60, and lower from that age on, while HDL-c is always higher in women. Total cholesterol was ≥250mg/dl in 14.6% of the sample and ≥200mg/dl in the 56.3%. Only 49.6% of people with total cholesterol ≥250mg/dl had been diagnosed and only 15.2% were under treatment. Age-adjusted total cholesterol was positively correlated with all cardiovascular risk factors. Furthermore, over 70% of the population presented, at least, one cardiovascular risk factor. CONCLUSIONS: The results above shows high levels of total cholesterol and LDL-c, low levels of HDL-c in males and the under diagnosis in clinical records. The association between hypercholesterolemia and other cardiovascular risk factors is similar to previous studies.