Emergencia de la cepa W135 causante de enfermedad meningocócica invasora en Chile 2012 / Emergence of W135 meningococcal serogroup in Chile during 2012

The epidemiologic behavior of the Invasive Meningococcal Disease (IMD) in Chile has changed. At the end of 2011, the W135 serogroup belonging to the hypervirulent clone ST-11 emerged. It affected diverse countries of the world, after the Mecca pilgrimage in 2000. In Chile, there have been 133 IMD cases during 2012. These figures represent an incidence of 0.7 per 100,000 inhabitants, which is 30% higher than expected. Eighty eight percent of cases were confirmed by the National Reference Laboratory at the Chilean Public Health Institute. The serogroup was determined in 103 strains and 58% belonged to the W135 serogroup, surpassing for the first time the B serogroup (37%). The Metropolitan Region concentrated 80% of these cases, and the remaining 20% affected other seven regions of the country. Forty seven percent of cases corresponded to children less than 5 years of age. The predominant clinical presentation of the W135 serogroup was a sepsis in 67% of cases. The fatality ratio of IDM during 2012 was 27%, the highest in the past 20 years. With this information, the Chilean Ministry of Health decreed a sanitary alert and implemented an integrated approach to control and prevent W-135 IDM, denominated "W-135 Action Plan".

Resultados de un programa multidisciplinario para el control del hábito tabáquico / Results of a multidisciplinary program to quit smoking

Background: Therapies to quit smoking are based on counseling, psychological therapy (PT), nicotine replacement therapy, bupropion or varenidine. Aim: To report the results of a multidisciplinary program to quit smoking Material and Methods: Patients agedl8years or more, motivated to quit smoking were admitted in a program based in counseling and PT, with or without pharmacological therapy. They were assessed by telephone during one year offollow up. Patients with unstable psychiatric diseases were excluded. Results were considered as "successful" when patients maintained abstinence during the year offollow up. A logistic regression analysis was done to identify factors associated with treatment success. Results: Between 2005 and 2011, 198 patients aged 45 ± 11 years (56% males), who smoked 31.5 ± 20.6 packages/year, were treated. Ofthese, 155 (78%) were treated with varenidine, 26 (13%) with bupropion and 17 (9%>) did not receive pharmacological therapy. One hundred sixty eightpatients completed the year offollow up. In 82 (49%>), treatment was successful and was negatively associated with a history of depression (odds ratio = 4 (95% confidence intervals 1.23-38.33). The main side effeets associated to varenidine and bupropion were nausea in 37 and 23%o, sleep disorders in 20 and 19%o and headache in 12 and 0%>, respectively Conclusions: A multidisciplinary program to quit smoking achieved a 49%> of abstinence during a year offollow up.

Exposición laboral a fluidos corporales de riesgo en el Hospital Clínico Félix Bulnes Cerda durante 11 años de estudio / Occupational exposure risk to body fluids in the Felix Bulnes Hospital during eleven years

Accidents with risk of occupational exposure to body fluids constitute more of a third of labor accidents. Objective: To describe the annual incidence of accidents with exposure to body fluids in the Felix Bulnes Hospital from1998 to 2008. Material and Methods: A retrospective analysis of reports from the Infection Control Committee. Results: During 11 years, there were 415 accidents with exposure to body fluids, with the cumulative incidence of 3,4% (range 1.3% to 6%). Sharp instrument accidents accounted for 92,5% of cases. The main health care providers affected were the paramedical technicians and the students. The highest frequency of accidents occurred in the obstetrical operating rooms (20%) and in the central operating rooms (17%). There were no cases of seroconversion and no exposure to HCV or HBV. The estimated costs were USD $35638,6 or USD $271 per 1000 staff per year. Conclusions: The incidence increased during the first years of the study and then remained stable since 2001, despite efforts in training personnel. Many factors contribute to the development of these accidents, such as lack of experience, type of clinical benefit and even daytime working hours.

Los accidentes por exposición a fluidos corporales de riesgo constituyen más de un tercio de los accidentes laborales. Objetivo: Describir la incidencia anual de accidentes por exposición a fluidos corporales de riesgo en el Hospital Clínico Félix Bulnes Cerda durante los años 1998 a 2008. Material y Métodos: Estudio descriptivo, retrospectivo, de análisis de reportes del Comité de infecciones asociadas a la atención de salud (IAAS). Resultados: Se registraron 415 accidentes por exposición a fluidos corporales de riesgo, siendo la incidencia acumulada de 3,4% (rango 1,3 a 6,0%) durante los 11 años estudiados. Los accidentes corto-punzantes constituyeron 92,5% de los casos. Los técnicos paramédicos y alumnos de carreras de la salud fueron los estamentos más afectados. La mayor frecuencia de accidentes ocurrió en los pabellones quirúrgicos de maternidad (20%) y en los pabellones centrales (17%). No se registraron casos de seroconversión y no hubo exposiciones a VHC o VHB. Los costos estimados fueron $ 17.292.916, $ 131.500 por 1.000 funcionario/ alumno por año (USD $ 34,571 o USD $ 263 por 1.000 funcionario/alumno por año). Conclusiones: La incidencia aumentó durante los primeros años del estudio para luego mantenerse estable desde el año 2001, a pesar de los esfuerzos realizados en capacitación. Muchos factores favorecen el desarrollo de estos accidentes, como la falta de experiencia, el tipo de prestación clínica e incluso la jornada laboral diurna.