Correlation of Qualitative Alpha1-microglobulin, Values of Interleukin 6, Cervicometry and Cervical Infection in Pregnant Women with Symptoms of Preterm Birth.

Background: One of the problems in modern obstetrics is how to identify and select pregnant women who are most likely to give premature birth. In the last ten years, due to false-positive test results, i.e., tests with low positive predictive values, there is an increase in unnecessary hospitalization days as well as unnecessary therapy. The probability of preterm birth is 25% in a population of pregnant women with symptoms of preterm birth. Objective: The aim was to analyze diagnostic accuracy of tests for the purpose of predicting premature births in< 37th and <34th week of pregnancy.Incidence of preterm births in < 37th week of pregnancy was 28%, while the incidence of preterm births up until 34th week of pregnancy, was < 8%. Methods: We included two groups of pregnant women in a prospective study; one group with the symptoms of threatening preterm birth between 22nd and 37th week of pregnancyand the other one of the same gestation period with no symptoms. Results: Each pregnant woman underwent test for placental alphamicroglobulin-1, cervical length screening, cervical sampling for microbiological analysis, blood sampling for IL6 and CRP analysis. There were 16% of preterm births, up until 7 days from hospitalization, and they were all PAMG-1 positive; There is 75% of preterm births if PAMG-1 is positive with cervical length under 25mm. Combining tests, we reached the best predictive accuracy with positive PAMG-1 test, cervical length under 15mm along with the increase of CRP values above 15.96%. Conclusion: Total number of hospitalization days was 29% with preterm births up to 71% with full term births regardless the symptomatology, which justifies further studies towards releasing the pressure from the health care system and from doctors as well in the process of reaching a decision on treatment of pregnant women with the signs of preterm birth.

Adult Food Allergy Prevalence: Reducing Questionnaire Bias.

BACKGROUND: Food allergy (FA) prevalence has increased in the last decades, but epidemiologic studies could show overestimated results. The objective of this study is to estimate the prevalence of immediate FA in adults in a region of Central Brazil, using a questionnaire to try to reduce misperceptions about FA reaction. METHODS: A cross-sectional study was conducted, enrolling an adult population aged 18-65 years comprised of families in a Central Brazilian city. In the first phase, participants answered a self-administered questionnaire for FA screening. In the second phase, the participants who reported an FA in the first questionnaire were visited to complete the second questionnaire applied by trained researchers. RESULTS: Of the 4,916 adults visited, 1,583 returned a completed questionnaire. Reported FA occurred in 171 (10.8%) subjects, and the more frequent citations were cow's milk, pork, fruits, shrimp, and vegetables. One hundred and four of these individuals completed the second questionnaire, and 15 (1.0%) were considered to have an FA diagnosis. The main foods were fruits, followed by cow's milk, shrimp, pork, and vegetables. CONCLUSION: After use of a specific questionnaire to recognize possible IgE-mediated FAs, a low frequency of FA was considered in this population. Use of a directed questionnaire administered by trained researchers could be an alternative for epidemiological IgE-mediated FA studies to achieve more accurate results.

First secondary case of Ebola outside Africa: epidemiological characteristics and contact monitoring, Spain, September to November 2014.

On 6 October 2014, a case of Ebola virus disease (EVD) acquired outside Africa was detected in Madrid in a healthcare worker who had attended to a repatriated Spanish missionary and used proper personal protective equipment. The patient presented with fever <38.6 °C without other EVD-compatible symptoms in the days before diagnosis. No case of EVD was identified in the 232 contacts investigated. The experience has led to the modification of national protocols.

[Chickenpox outbreak in Herrera del Duque, Badajoz, Spain]. / Brote de varicela en Herrera del Duque (Badajoz).

INTRODUCTION: Chickenpox is a worldwide disease with high morbidity but few complications, although complications can be sevre in immunocompromised individuals and healthy adults. The annual chickenpox rate declared to the National Notification Disease Surveillance System is approximately 5 cases per 1,000 inhabitants in Extremadura (Spain). The aim of this study was to identify and describe the characteristics and cost of an epidemic outbreak of chickenpox in Extremadura. METHODS: Between November 2000 and March 2001, a descriptive study was performed. Cases of chickenpox were actively sought in a cohort of schoolchildren in Herrera del Duque (Badajoz). The protocols of the Monitoring Network of the Autonomous Community of Extremadura was used for case definition. Microbiological confirmation was performed by isolation of the virus and the presence of IgM and IgG markers in serum. We analyzed the direct and indirect tangible costs as well as the intangible costs of the outbreak. RESULTS: Seventy-five cases were identified, of which 94.7% occurred in children aged between 1-9 years, mainly boys. The attack rate was 18.5 cases per 1,000 inhabitants and 68.2% occurred in children aged less than 10 years charing a home. The clinical course was benign, without hospital admissions or complications. A total of 71.6% of children aged between 3 and 8 years were susceptible. A possible temporary aggregation of cases in the school was analyzed and a relative risk of 5.01 (p < 0.0001) was obtained. The virus was isolated in the 4 vesicle samples studied and serology was positive (IgM) in the 9 serum samples studied. The total cost of the outbreak was of 927,21 e, with a mean of 12,53 e per case and 205 school days lost. CONCLUSION: A chickenpox outbreack was confirmed in Herrera del Duque, with person-to-person transmission, affecting children aged between 1 and 9 years. The high susceptibility of the pupils, the characteristics of teaching, and the meetings prior to the carnivals played a determining role in the transmission of the epidemic. The estimated cost of this outbreak was 76% less than the cost that would have been generated by single-dose vaccination of the 75 individuals who contracted the disease.

Brote de varicela en Herrera del Duque (Badajoz) / Chickenpox outbreak in Herrera del Duque, Badajoz, Spain

Introducción: La varicela es una enfermedad de distribución mundial con una elevada morbilidad y pocas complicaciones, aunque puede presentar cuadros clínicos graves en inmunodeprimidos y adultos sanos. El objeto de este estudio es identificar y describir las características y los costes de un brote epidémico en Extremadura, cuya tasa anual de casos declarados al sistema de Enfermedades de Declaración Obligatoria (EDO) oscila en alrededor de 5 por 1.000 habitantes. Métodos: Estudio descriptivo con búsqueda activa de casos entre los meses de noviembre del año 2000 y marzo de 2001, y de la susceptibilidad de la cohorte escolarizada del colegio de Herrera del Duque (Badajoz). Las definiciones de casos fueron recogidas de los protocolos de la Red de Vigilancia de la comunidad extremeña. La confirmación microbiológica se realizó por aislamiento del virus y por presencia de marcadores IgM e IgG en el suero del enfermo. Se analizaron los costes tangibles directos e indirectos y los no tangibles del brote. Resultados: De los 75 casos identificados, 71 (94,7 por ciento) eran niños de entre uno y 9 años, predominando el sexo masculino. La tasa de ataque fue de 18,5 casos por 1.000 habitantes, y del 68,2 por ciento en convivientes menores de 10 años. La evolución fue benigna, sin ingresos hospitalarios ni complicaciones. Se encontró un 71,6 por ciento de niños susceptibles en los de entre 3 y 8 años. Se analizó una posible agregación temporal de casos en el colegio, obteniéndose un riesgo relativo (RR) de 5,01 (p < 0,001). Se aisló el virus en las 4 muestras de vesículas estudiadas y la serología (IgM) fue positiva en los 9 sueros estudiados. El coste total de brote fue de 927,21 e, con una media de 12,53 e por caso, y 205 días de pérdida escolar. Conclusión: Se confirmó la existencia de un brote de varicela en el colegio de la localidad de Herrera del Duque, con transmisión persona a persona, que afectó a niños de entre uno y 9 años. La elevada susceptibilidad del alumnado, las características de la docencia y las reuniones previas a los carnavales tuvieron un papel determinante en la propagación de la epidemia. El coste estimado para este brote se corresponde con un gasto un 76 por ciento menor del producido por la vacunación con una dosis de los 75 casos de este brote (AU)

Evaluation of the measles, mumps and rubella immunisation programme in Spain by using a sero-epidemiological survey.

In Spain, measles, mumps and rubella vaccination was introduced in 1981, with one dose at the age of 15 months and another at the age of 11 years being administered since 1995. Reported disease incidence was less than one case per 100,000 people for measles and rubella, and 23 cases per 100,000 people for mumps. A seroepidemiological survey was undertaken to estimate the frequency of susceptible individuals by age and environment; and vaccination coverage and efficacy of the vaccines administered. A population-based cross-sectional study was then conducted, covering the population aged 2-39 years, residing in Spain (excluding Catalonia). The sample was stratified by age and rural/ urban environment and informed consent obtained to take blood specimens from subjects attending blood-extraction centres. The final sample totalled 3,932 persons. IgG antibodies were detected by an enzyme-linked immunosorbent assay. Estimated vaccination coverage was 96% for children aged 2-5 years; vaccine efficacies were 96.7% for measles, 97.2% for rubella and 79.3% for mumps. Immunity was the lowest in the 6-9 year age group for measles (90.8%) and in males aged between 15 and 24 years for rubella (86 and 89.8%, respectively). In the case of mumps, this proved the lowest in the 2-5 year age group (76.7%) and in those autonomous regions in which only the Rubini strain had been administered. The incidence of measles has enabled the National Measles Elimination Plan to be implemented by which the elimination of congenital rubella syndrome could now be initiated. A possible explanation for the higher susceptibility observed for mumps might lie in the Rubini strain's low efficacy.

Age-specific seroprevalence of poliomyelitis, diphtheria and tetanus antibodies in Spain.

In 1996, a seroepidemiological study was undertaken in Spain, with the main aim of estimating the population's immunity against poliomyelitis, tetanus and diphtheria. A population-based cross-sectional study was conducted, covering the population aged 2-39 years. The sample was stratified by age and rural-urban environment, and informed consent obtained to take blood specimens from subjects attending phlebotomy centres. The study included 3,932 persons and the prevalence of antibodies against all three types of poliovirus exceeded 94% across all age groups. From a high of 96% in subjects under the age of 15 years, immunity against diphtheria steadily declined to a low of 32.3% in subjects aged 30-39 years. Similarly, tetanus antitoxin concentrations indicating basic protection were present in 98.9% of the under-14 years age group; thereafter, immunity declined, until reaching 54.6% in the 30-39 years age group.

Seroprevalence of HIV and HTLV in a representative sample of the Spanish population.

HIV and HTLV seroprevalence was determined by means of unlinked anonymous testing of 2144 sera, originally obtained from primary care patients by representative sampling of the Spanish population aged 15-39 years in 1996. HIV-1 seroprevalence was 4.3 per 1000 population in the 15-39 years age group [95% confidence interval (CI), 1.5-10.7] and 5.6 per 1000 (95% CI, 1.8-15.3) in the 20-39 years age group. Seroprevalence proved higher in males and urban residents. No antibodies to HIV-2 and HTLV-I were detected in any of the sera studied. However, presence of antibodies to HTLV-II was confirmed in one serum sample, while HTLV seroreactivity, though detected in another, could not be typed. The two HTLV-positive results equated to a seroprevalence of 1.9 per 1000 in the 20-39 years age group (95% CI, 0.3-8.6). HIV-I seroprevalence was consistent with previous estimates yielded by back-calculation. The level of HTLV seroprevalence found suggests endemicity.

[Prevalence of types of hepatitis C virus in Spanish blood donors: results of a state-based multicenter study. Spanish Group for the Study of Blood Donors with Risk of HCV Transmission]. / Prevalencia de tipos del virus de la hepatitis C en donantes de sangre españoles: resultados de un estudio multicéntrico de ámbito estatal. Grupo Español de Estudio de Donantes de Sangre en Riesgo de Transmisión del VHC (GEDSRT-VHC).

BACKGROUND: The prevalences established up to the present in Spain for the different types of hepatitis C virus are based on data obtained in populations in which the nature of the population itself may have based the data in favor of certain types of the virus. The study of seropositive blood donors identified through screening of blood donations may provide prevalences closer to the truth among the general population. MATERIALS AND METHODS: Typing of genomes in samples from 441 donors was performed using the blood bank generated during the multicenter study performed by the Spanish Study Group of Blood Donors with Risk of Transmission of the Hepatitis C Virus. The antibodies present were typed in the seropositive samples in the above donors and in 337 more in whom a viral genoma was not detected. RESULTS: In total, the infection was typed in 685 donors. On analysis of the results corresponding to 386 donors, whose number and distribution by autonomous communities were previously fixed to represent all of Spain, type 1 was largely the more prevalent (85.5%) followed by types 3 (4.4%), 2 (4.1%), 4 (3.4%) and 5 (0.5%) and by a group of apparent mixed infections which altogether represented 2.1% of the total. Among the donors in whom the genomes were typed, infectious due to the 1b subtype (78% of the 441 samples genotypes) clearly predominated. The participation of the different types of type 1 was significantly greater in those lacking antibodies detectable versus epitopes codified in the NS4 region of the viral genome. CONCLUSIONS: This study avoids some bias in sampling which may have affected previous studies and provides data which should more closely approach the real prevalence in the general Spanish population. Thus, it should provide a better base of comparison for any study on the distribution of the types of the hepatitis C virus in selected populations or others performed during tha investigation of outbreaks of hepatitis C virus infection.

Injecting drug use as risk factor for visceral leishmaniasis in AIDS patients.

In Madrid Region 6652 AIDS cases were diagnosed between 1982 and 1993. Visceral leishmaniasis (VL) was present in 166 (2.49%). VL frequency among injecting drug users proved higher than that for the other transmission categories (relative risk 2.57; 95% confidence interval 1.64-4.01). This could point to an alternative Leishmania transmission route via needle sharing.

In vitro susceptibility of Plasmodium falciparum to chloroquine, amodiaquine, quinine, mefloquine, and sulfadoxine/pyrimethamine in Equatorial Guinea.

Between March 1990 and June 1992, a study was carried out in Equatorial Guinea on the in vitro response of Plasmodium falciparum to different antimalarial drugs. Field work for the study was conducted both in the country's island region as well as on the mainland, and resistant isolates were found to exhibit interregional differences. On the island of Bioko, 204 tests were performed with 16% (11 of 69) resistant to chloroquine, 9% (4 of 46) resistant to quinine, 14% (6 of 43) resistant to a combination of sulfadoxine/pyrimethamine, and 6.5% (3 of 46) resistant to amodiaquine. In the mainland area of Bata, the same antimalarial drugs and mefloquine were tested with the following results: 9% (5 of 58) resistant to chloroquine; 2% (1 of 58) resistant to amodiaquine, and 3% (2 of 58) resistant to a combination of sulfadoxine/pyrimethamine. No isolates resistant to quinine or mefloquine were found. Effective concentrations (EC50, EC90, and EC99) and regression lines (log dose/response) for each antimalarial drug were calculated to establish a surveillance system for antimalarial drug chemosensitivity in Equatorial Guinea. Finally, 12 isolates from 12 patients previously treated with chloroquine were studied to compare both tests (in vivo-in vitro) and obtain a correlation between the RII and RIII types of in vivo and in vitro resistances. No correlation for the RI type was found between the two methods.

Trends in hepatitis A virus infection with reference to the process of urbanization in the greater Madrid area (Spain).

Hepatitis A is an infection transmitted by the fecal-oral route. Endemicity within a specific country is directly related to sanitation and hygienic standards, while being inversely related to socioeconomic conditions. We studied how the process of urbanization witnessed in Madrid had influenced the transmission of hepatitis A infection. In the Madrid Autonomous Region, this process first began in the early sixties and was not brought to a close until the late seventies. Catalytic models were used to estimate the annual infection rate, lambda, on the basis of seroprevalence data stratified by age. A cohort effect related to a fall-off in infancy-related hepatitis A virus (HAV) is to be observed in the results for the last few years. The model permits four birth cohort-based groups to be differentiated by lambda: individuals born pre-1960, lambda = 0.082 (95% CI 0.095-0.070); those born in the early sixties, lambda = 0.052 (95% CI 0.060-0.042); whose members were born in the late sixties, lambda = 0.033 (95% CI 0.041-0.025); and those born in the late seventies, lambda = 0.017 (95% CI 0.020-0.013). The first group includes those born before the urbanization process had started. The second and third groups coincide with the development stage of that process, hence exhibiting transitional rates. The fourth group reflects the process in its consolidation stage. This reduction in the transmission of infection has changed the manner of presentation, so that while isolated cases or small outbreaks tend to be more common nowadays, occasionally epidemics may evolve explosively. The average age at presentation has risen and the likelihood of symptomatic infection is higher.

Epidemiology of canine leishmaniasis in the Madrid region, Spain.

A cross-sectional serological survey was carried out in the Madrid Autonomous Region (Comunidad de Madrid) in order to study and describe canine leishmaniasis epidemiology. The presence of leishmaniasis-specific antibodies was ascertained by immunofluorescence testing, 591 dogs were screened, revealing a prevalence of 5.25% (95% confidence interval 7.4-3.6), with no difference being encountered between rural and periurban areas. Age-specific prevalence exhibits a peak at 2-3 years and another at 7-8 years. Incidence or force of infection by occupation is as follows: pet dogs 0.059 (95% confidence interval 0.009-0.108) and working dogs 0.035 (95% confidence interval 0.012-0.057), there being a ratio between infection rates of 1.7, viz., indicating a 70% greater risk of infection among pet than among working dogs. The basic case reproduction number R0 is 1.06, suggesting that very intense control measures would not be needed for a drop in prevalence and incidence of infection to be achieved.

Field evaluation of fluorescence microscopy (QBC) for malaria diagnosis

Quantitative Buffy Coat (QBC) for malaria test was used under field conditions. Firstly; it was confronted with thick film in 720 specimens taken during field surveys. Sensitivity; efficiency and estimation of the personnel training and handling of QBC was done; considering its feasibility in a control programme in a developing country with hyperendemic malaria. Secondly; with 618 positive specimens taken at hospital; it was developed a method of converting the QBC parasite count into parasitaemia per mm3 of blood. The specificity of the QBC tube was 82.1 per cent; indicating malaria in 35 of 196 negative slides. the main handicaps are those concerning species identification other than Plasmodium falciparum. The species was correctly identified in 90.4 pour cent of specimens. Giemsa stained thick and thin blood films remains the method of choise for the diagnosis of malaria in the field

Application and evaluation of QBC malaria diagnosis in a holoendemic area.

Quantitative Buffy Coat Analysis was used in practical diagnosis situations. In the first place, sensitivity and specificity was measured in an active search survey (720 schoolchildren under 10 years of age, in nine field trips) under unfavourable laboratory conditions (onsite school diagnosis being conducted with electricity supplied by a diesel-powered generator). In this group, the QBC-based study revealed sensitivity and specificity ratings of 99.6% and 81.7% respectively. QBC proved 5.5% more sensitive than the thick-film method, but specificity was greater with the latter. QBC returned good results when used in adverse situations, viz., in the absence of air conditioning and with a diesel generator as the only power supply. QBC was used in a passive search survey (hospital group, 618 children) under good laboratory conditions (air conditioning) with patients enrolled in a trial to measure resistance to antimalarial drugs. In this survey we targeted at assessing the efficacy of chloroquine treatment at dose of 25 mg/kg/3 days. QBC proved more sensitive than the thick-film method, detecting - on day 14 of the in vivo test - low parasitaemias that had gone undetected by thick film. Lastly, this study reports on the conversion of QBC readings (parasitaemia per field) into thick-field terms (number of parasites per microliter of blood), with the aim of measuring the degree of recurring parasitaemia.

Infectivity of dogs naturally infected with Leishmania infantum to colonized Phlebotomus perniciosus.

A study was carried out on the infectivity to sandflies of 16 dogs naturally parasitized by Leishmania infantum. All dogs were seropositive and the parasite had been isolated from all except one. They were divided into 3 clinical groups: 5 asymptomatic, 4 oligosymptomatic, and 7 polysymptomatic dogs. The dogs were exposed to female Phlebotomus perniciosus from a local colony and 7 d later the fed females were dissected in order to determine their rate of infection. There was wide variability of the percentage of fed and infected sandflies within each clinical group of dogs, with no significant difference between the 3 groups; the infectivity to sandflies was independent of the extent of symptoms in the dogs.

Resistance of Plasmodium falciparum to antimalarial drugs in Equatorial Guinea.

One hundred and sixty-six children from Equatorial Guinea, all under 10 years of age and with acute uncomplicated falciparum malaria, were randomly allocated to four groups and treated with one of the following regimens: chloroquine or amodiaquine (25 mg base/kg body weight over 3 days), quinine (8 mg/kg every 8 h for 3 or 5 days), and sulphadoxine-pyrimethamine (25-1.25 mg/kg, in one dose). The parasite clearance rates up to day 14 were 28% with chloroquine, 74% with amodiaquine, and 95% with quinine or sulphadoxine-pyrimethamine. The times required to clear asexual blood forms of Plasmodium falciparum in sensitive cases were 64, 70, 73 and 65 h, respectively. Although quinine and sulphadoxine-pyrimethamine are equally effective, quinine is recommended for treatment of multidrug-resistant malaria in paediatric patients, essentially because of the risk of serious reactions to sulpha drugs. Health providers are, however, encouraged to keep supplies of sulphadoxine-pyrimethamine as an option and to refer patients quickly, if required.

Baseline entomological data for a pilot malaria control program in Equatorial Guinea.

Entomological studies conducted on the island of Bioko and the mainland province, Río Muni, in Equatorial Guinea provided baseline data for a pilot malaria control program. The main species collected resting in houses at low density were Anopheles gambiae s.l. Giles and Anopheles funestus Giles. An. gambiae s.l. density increased during the rainy season, whereas An. funestus populations remained stable during both dry and wet seasons. Both species tended to be endophilic and were not collected resting or biting outdoors. Overall, delayed sporozoite rates were about 10% for both species and were highest in the dry season. An. gambiae s.l. from the mainland showed resistance to 4% DDT, but the island population was still susceptible. All populations were completely susceptible to 5% malathion and 0.025% deltamethrin.