Risk mapping of West Nile virus circulation in Spain, 2015.

West Nile fever is an emergent disease in Europe. The objective of this study was to conduct a predictive risk mapping of West Nile Virus (WNV) circulation in Spain based on historical data of WNV circulation. Areas of Spain with evidence of WNV circulation were mapped based on data from notifications to the surveillance systems and a literature review. A logistic regression-based spatial model was used to assess the probability of WNV circulation. Data were analyzed at municipality level. Mean temperatures of the period from June to October, presence of wetlands and presence of Special Protection Areas for birds were considered as potential predictors. Two predictors of WNV circulation were identified: higher temperature [adjusted odds ratio (AOR) 2.07, 95% CI 1.82-2.35, p<0.01] and presence of wetlands (3.37, 95% CI 1.89-5.99, p<0.01). Model validations indicated good predictions: area under the ROC curve was 0.895 (95% CI 0.870-0.919) for internal validation and 0.895 (95% CI 0.840-0.951) for external validation. This model could support improvements of WNV risk- based surveillance in Spain. The importance of a comprehensive surveillance for WNF, including human, animal and potential vectors is highlighted, which could additionally result in model refinements.

Updated distribution of Aedes albopictus (Diptera: Culicidae) in Spain: new findings in the mainland Spanish Levante, 2013.

In 2004, Aedes (Stegomyia) albopictus (Skuse, 1894) was observed for the first time in Catalonia, northeastern Spain. A decade later, it has spread throughout the eastern Mediterranean region of the country and the Balearic Islands. Framed within a national surveillance project, we present the results of monitoring in 2013 in the autonomous communities of the mainland Levante. The current study reveals a remarkable increase in the spread of the invasive mosquito in relation to results from 2012; the species was present and well-established in 48 municipalities, most of which were along the Mediterranean coastline from the Valencian Community to the Region of Murcia.

Updated distribution of Aedes albopictus (Diptera: Culicidae) in Spain: new findings in the mainland Spanish Levante, 2013

In 2004, Aedes (Stegomyia) albopictus (Skuse, 1894) was observed for the first time in Catalonia, northeastern Spain. A decade later, it has spread throughout the eastern Mediterranean region of the country and the Balearic Islands. Framed within a national surveillance project, we present the results of monitoring in 2013 in the autonomous communities of the mainland Levante. The current study reveals a remarkable increase in the spread of the invasive mosquito in relation to results from 2012; the species was present and well-established in 48 municipalities, most of which were along the Mediterranean coastline from the Valencian Community to the Region of Murcia.

Riesgo epidémico de la enfermedad asociada a una nueva cepa de Clostridium difficile / Epidemic risk of disease associated with a new strain of Clostridium difficile

Clostridium difficile ha puesto en alerta a los profesionales sanitarios en los últimos años por el incremento de su incidencia en Norteamérica y Europa. En brotes nosocomiales y en casos adquiridos en la comunidad, se ha identificado una cepa de C. difficile caracterizada como tipo toxinogénico III, ribotipo por PCR 027 (C. difficile 027), que tiene una patogenicidad mayor debido a la hiperproducción de exotoxinas y presenta un perfil de resistencia a antibióticos característico. En Europa, desde 2003, varios países han notificado casos de enfermedad asociada a C. difficile 027, lo que demuestra su rápida diseminación. En este artículo se revisan los últimos brotes asociados a C. difficile 027, que indican la necesidad de establecer un sistema de vigilancia homogéneo para la detección temprana y la toma de medidas de control que permitan disminuir la extensión de los brotes desde su inicio (AU)

The incidence of Clostridium difficile infection in North America and Europe has increased in the last years, generating concern among health professionals. A new strain of C. difficile has been identified in recent nosocomial outbreaks and community-acquired infections. This new strain, characterized as toxigenic type III, PCR ribotype 027 (C. difficile 027), presents higher pathogenicity because of increased exotoxin production, and a characteristic antibiotic resistance profile. Since 2003, several European countries have notified cases of C. difficile 027-associated disease, a fact that demonstrates its rapid dissemination. In this article, we review the latest nosocomial outbreaks associated with this new strain, which illustrate the need for a standardized surveillance system for early detection and implementation of control measures aimed at reducing the spread of this microorganism (AU)

[Epidemic risk of disease associated with a new strain of Clostridium difficile]. / Riesgo epidémico de la enfermedad asociada a una nueva cepa de Clostridium difficile.

The incidence of Clostridium difficile infection in North America and Europe has increased in the last years, generating concern among health professionals. A new strain of C. difficile has been identified in recent nosocomial outbreaks and community-acquired infections. This new strain, characterized as toxigenic type III, PCR ribotype 027 (C. difficile 027), presents higher pathogenicity because of increased exotoxin production, and a characteristic antibiotic resistance profile. Since 2003, several European countries have notified cases of C. difficile 027-associated disease, a fact that demonstrates its rapid dissemination. In this article, we review the latest nosocomial outbreaks associated with this new strain, which illustrate the need for a standardized surveillance system for early detection and implementation of control measures aimed at reducing the spread of this microorganism.

Las competencias profesionales en Salud Pública / Professional competencies in public health

No disponible

[Disease burden due to vaccinable diseases in the Spanish population aged less than 15 years old]. / Carga de enfermedad atribuible a las afecciones inmunoprevenibles en la población infantojuvenil española.

OBJECTIVES: To estimate the burden of disease due to vaccinable diseases and the relative importance of these diseases in the health of the Spanish population aged less than 15 years old. METHODS: Disease burden was measured in disability-adjusted life years (DALYs). DALYs were computed by adding years of life lost (YLL) to years lived with disability (YLD). The DALYs of the Spanish population aged less than 15 years old were estimated for 1999 and were stratified by diseases according to the classification system of the Global Burden of Disease (adapted to the aim of the study), age group and gender. Diseases included in the childhood vaccination schedule, varicella, and pneumococcal disease were targeted for this study. The sources used were: the national mortality register to compute YLL, the Epidemiologic Surveillance National Network, hospital discharge data (CMBD) and the scientific literature to compute YLD due to vaccinable diseases, and World Health Organization estimates (Euro-A) or, when these were lacking, morbidity hospital data (Hospital Morbidity Survey) to compute the YLD due to non-vaccinable diseases. RESULTS: The burden of disease due to vaccinable diseases was 1.2% of global DALYS (the overall DALYs rate was 46,57/1,000 habitants): excluding meningococcal disease (0.5% to 3.3%), diseases included in the vaccination schedule represented 0.00% to 0.03%, depending on age groups, except meningococcal infection (between 0.5% and 3.3%). Pneumococcal meningitis represented 0.06% to 0.65% and varicella 0.00% to 0.15%, also depending on age groups. CONCLUSIONS: Disease burden due to vaccinable diseases is a good indicator of the health of the young population in Spain. This measure summarizes and combines information on mortality, morbidity and disability caused by diseases. The DALYs attributable to diseases included in the vaccination schedule demonstrate that immunization programs have achieved their goals.

Carga de enfermedad atribuible a las afecciones inmunoprevenibles en la población infantojuvenil española / Disease burden due to vaccinable diseases in the Spanish population aged less than 15 years old

Objetivos: Estimar la carga de enfermedad de las afecciones inmunoprevenibles y describir su importancia relativa en la salud de la población infantil y juvenil española. Métodos: La unidad de medida es años de vida ajustados por discapacidad (AVAD). Los AVAD resultan de sumar las pérdidas de salud por muerte prematura (AVP) y las pérdidas de salud por discapacidad (AVD). Se ha estimado los AVAD de la población española menor de 15 años para 1999 desagregados por: enfermedades según el sistema de clasificación de carga global de enfermedad (adaptada al objetivo del estudio), por grupos de edad y sexo. Las enfermedades objeto del estudio son las incluidas en calendario vacunal infantil, la varicela y la enfermedad neumocócica. Las fuentes consultadas son: para el cálculo de AVP, el registro de mortalidad nacional; para el cálculo de AVD de las enfermedades inmunoprevenibles, datos de la RENAVE, CMBD y fuentes bibliográficas, y para los AVD de las no inmunoprevenibles, inferencia de las estimaciones de la OMS (Euro-A) y, en su defecto, a partir de datos de incidencia de la EMH. Resultados: La tasa de AVAD global es de 46,57/1.000 habitantes, y las enfermedades objeto del estudio representan el 1,2 por ciento del total de la carga de enfermedad: las enfermedades incluidas en el calendario de vacunaciones representan, según el grupo de edad, entre el 0,00 y el 0,03 por ciento, excepto la infección meningocócica (entre el 0,5 y el 3,3 por ciento). La meningitis neumocócica representa el 0,06-0,65 por ciento y la varicela, el 0,00-0,15 por ciento, según el grupo de edad. Conclusiones: La carga de enfermedad es un buen indicador para definir la salud de la población infantojuvenil española, ya que es una medida "sintética" que integra información sobre mortalidad, morbilidad y discapacidad de las enfermedades. Los AVAD atribuibles a las enfermedades inmunoprevenibles incluidas en el calendario nos permiten afirmar que los programas de vacunación han conseguido su objetivo (AU)

[Laboratory diagnosis of pertussis. Role of serology]. / Diagnóstico de laboratorio de tos ferina. Papel de la serología.

Culture is the reference method for the diagnosis of infection by Bordetella pertussis. Nevertheless, delayed sample collection and previous antibiotic treatment can limit culture sensitivity. In principle, direct immunofluorescence provides immediate diagnosis. It is, however, a subjective procedure that shows low sensitivity and specificity. PCR techniques increase culture sensitivity while maintaining high specificity, but their performance decreases along the evolution of the disease. Serologic methods are the main alternative for cases in which diagnosis is delayed. Current recommendations center on ELISA techniques that include purified antigens, such as filamentous hemaglutinin, and particularly, pertussis toxin. Traditionally, serological diagnosis requires confirmation by demonstrated seroconversion, but now the possibility of diagnosis based on titration of a single serum sample is being evaluated.