Community-wide measles outbreak in the Region of Madrid, Spain, 10 years after the implementation of the Elimination Plan, 2011-2012.

We describe a community-wide outbreak of measles due to a D4 genotype virus that took place in the Region of Madrid, Spain, between February 2011 and August 2012, along with the control measures adopted. The following variables were collected: date of birth, sex, symptoms, complications, hospital admission, laboratory test results, link with another cases, home address, places of work or study, travel during the incubation period, ethnic group, and Mumps-Measles-Rubella (MMR) vaccination status. Incidences were calculated by 100,000 inhabitants. A total of 789 cases were identified. Of all cases, 36.0% belonged to Roma community, among which 68.7% were 16 months to 19 y old. Non-Roma cases were predominantly patients from 6 to 15 months (28.1%) and 20 to 39 y (52.3%). Most cases were unvaccinated. We found out that 3.0% of cases were healthcare workers. The first vaccination dose was brought forward to 12 months, active recruitment of unvaccinated children from 12 months to 4 y of age was performed and the vaccination of healthcare workers and of members of the Roma community was reinforced. High vaccination coverage must be reached with 2 doses of MMR vaccine, aimed at specific groups, such as young adults, Roma population and healthcare workers.

Effectiveness of 23-valent pneumococcal polysaccharide vaccine in adults aged 60 years and over in the Region of Madrid, Spain, 2008-2011.

Invasive pneumococcal disease (IPD) is a notifiable disease in the Region of Madrid. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for children and adults aged two years or over with a high risk of disease, and for all adults aged 60 and over. We describe the evolution of IPD incidence from 2008 to 2011 in people aged 60 years and over and PPV23 vaccine effectiveness (VE). VE is estimated using both the screening method and indirect cohort method. The incidence of IPD varied from 20.0 in 2008 to 15.2 per 100,000 inhabitants in 2011 (RR: 0.8; 95% CI: 0.6­0.9). Adjusted VE estimated with the screening method was 68.2% (95% CI: 56.2­76.9). VE with the Broome method was 44.5% (95% CI: 23.8­59.6) for all PPV23 serotypes, and 64.4% (95% CI: 45.2­76.8) for PPV23 serotypes not included in conjugate vaccines. VE was lower in patients aged 80 years and older (25.5%; 95% CI:-23.2 to 55.0) and those with highrisk medical conditions (31.7%; 95% CI: -2.2 to -54.4). Adjusted VE was 44.5% (95% CI: 19.4-61.8) within 5 years of vaccination and 32.5% (95% CI: -5.6 to 56.9) after 5 years. These results are compatible with current recommendations for PPV23.

Brote de hepatitis A en una escuela infantil y transmisión intrafamiliar de la infección / Hepatitis outbreak in a day care center and household transmission

Antecedentes En una escuela infantil de Madrid se ha producido entre octubre de 2002 y febrero de 2003 un brote de hepatitis A que se ha diseminado a las familias de los alumnos. Pacientes y métodos Se realiza estudio descriptivo del brote y de las medidas de control adoptadas. Resultados El brote afectó a 23 personas: ocho alumnos entre 1 y 3 años (tasa de ataque 8,7 por ciento), dos trabajadores (tasa de ataque 10,5 por ciento) y 13 contactos familiares. Diecisiete de los 23 casos han sido confirmados mediante serología y ocho precisaron ingreso hospitalario. Las medidas de control fueron: a) intensificación de las prácticas higiénicas generales en la escuela y en los hogares, específicamente en el cambio de pañal, y b) vacunación de todos los alumnos mayores de 1 año (92 niños), de los trabajadores (16 adultos) y de los familiares convivientes de los casos. Tras la vacunación, la curva epidémica muestra exclusivamente transmisión intrafamiliar. Los casos en familiares han sido adultos relacionados con alumnos asintomáticos. Conclusiones La vacunación ha demostrado ser una medida eficaz en el control del brote epidémico dentro de la escuela infantil. Sin embargo, cuando se produce un brote se debería indicar la vacunación a los convivientes de todos los alumnos -con o sin sintomatología de hepatitis A-, en especial padres y hermanos. También debería hacerse efectiva la recomendación de vacunación de los trabajadores de escuelas infantiles al inicio de su actividad laboral, ya que no se realiza de manera sistemática. La vacunación universal sería la medida más eficaz para prevenir brotes en centros escolares (AU)

[Hepatitis A outbreak in a day care center and household transmission]. / Brote de hepatitis A en una escuela infantil y transmisión intrafamiliar de la infección.

BACKGROUND: An outbreak of hepatitis A occurred in a day care center in Madrid between October 2002 and February 2003 and spread to the children's families. PATIENTS AND METHODS: We performed a descriptive study of this outbreak and of the control measures adopted. RESULTS: The outbreak affected 23 people: eight children aged 1-3 years (attack rate= 8.7 %), two staff members (attack rate=10.5 %), and 13 household contacts. Of the 23 cases, 17 were confirmed by serology and eight patients were hospitalized. The control measures were: (i) increasing general hygiene measures in the home and school and, in particular, those concerning diaper changing by staff, and (ii) vaccination of all pupils aged more than one year (92 children), staff members (16 adults) and family contacts of affected individuals. After vaccination, the epidemic curve showed intrafamilial transmission exclusively. Cases among familial contacts affected adults in contact with asymptomatic children. CONCLUSIONS: Vaccination was effective in controlling the epidemic outbreak within the day care center. However, when outbreaks occur, vaccination should be prescribed to close contacts of all the children, whether symptomatic or not, especially parents and siblings. The recommendation that day care center workers undergo vaccination on taking up their posts should be put into practice, since vaccination is not systematically performed. General vaccination would be the most effective measure for preventing outbreaks in educational centers.

[Evolution of meningococcal disease in the community of Madrid. Effectiveness of antimeningococcal A+C vaccination]. / Evolución de la enfermedad meningocócica en la Comunidad de Madrid. Efectividad de la vacunación antimeningocócica A + C.

BACKGROUND: In 1997 (between 22 September and 14 November) an A + C meningococcal mass vaccination campaign was carried out in Madrid, targeting the age group of from 18 months to 19 years of age, in the face of an increase in the number of cases of meningococcal disease caused by serogroup C occurring in the 1996-97 season. This study forms a part of the impact assessment of that campaign. METHODS: The evolution of the meningococcal disease, by means of the comparison of rates of incidence; and the efficacy of the vaccination campaign was determined after one year (1997-98 season) and after two years (1997-98 and 1998-99 seasons) of monitoring. The vaccine efficacy has been calculated as [1-(Incidence rate in vaccinated/Incidence rate in unvaccinated)]* 100. RESULTS: A significant drop was registered in the incidence of serogroup C meningococcal disease on comparing the 1997-98 and 1998-99 seasons with the epidemic season (1996-97). The vaccine efficacy after two years of monitoring subsequent to the vaccination campaign was 76.9% for the global population between 18 months and 19 years of age and 88.5% in the group of vaccinated individuals between 15 and 19 years of age. CONCLUSIONS: The vaccine efficacy obtained is compatible with that described in the relevant literature. The significant reduction in the incidence of meningococcal disease caused by serogroup C was due to the vaccine efficacy obtained.

[Recent transmission of tuberculosis in Madrid (Spain): usefulness of molecular techniques]. / Transmisión reciente de la tuberculosis en Madrid: utilidad de las técnicas moleculares.

BACKGROUND: Recent studies suggest that many tuberculosis cases in urban areas result from recent transmission. The aim of this study was to determine patterns of tuberculosis transmission in Madrid. PATIENTS AND METHODS: A prospective population-based molecular epidemiological study of patients diagnosed of tuberculosis was conducted in three urban districts of Madrid (455.050 inhabitants) during 1997-1998. Clinical, demographic and epidemiological data were reviewed. Patients were included in clusters when their isolates contained: a) six or more IS6110 bands in an identical pattern, or b) five or fewer IS6110 bands that matched identically and had an identical spoligotyping pattern. RESULTS: Of 207 positive-culture patients, 148 (71,5%) were DNA fingerprinted. A total of 18 clusters which included 62 patients (41,9%) were identified. Clusters contained between 2 and 12 cases. Risk factors for clustering included: age < 35 years (OR = 4,1, 95% CI: 1,9-8,9), injection drug use (OR = 4,7, 95% CI: 1,6-14,8), HIV infection (OR = 2,7, 95% CI: 1,1-6,8), and a history of imprisonment (OR = 2,9, 95% CI: 1,2-7,2). The epidemiological investigation identified connections among 27% of clustered patients. CONCLUSIONS: A high proportion of cases of tuberculosis in urban Madrid result from recent transmission. Molecular epidemiology studies give valuable information for urban tuberculosis control.

[Study of hypercholesterolemia among the child population of Valdemoro]. / Estudio de la hipercolesterolemia en la población infantil de Valdemoro.

We studied 99 children with ages ranging from 0 to 14 years, randomly selected from the census of Valdemoro (Madrid) and stratified by sex and age. The clinical records of all the children were completed and the levels of total serum cholesterol were assessed. The average cholesterol level for the total sample was 159 +/- 31 mg/dl (m +/- sd). Twenty-six children (26.3%) had values above 175 mg/dl [75th percentile of the Lipid Research Clinics Program(LRCP)], with no significant differences between the values of such percentile in both studies. Ten per cent of the children showed cholesterolemias greater than 200 mg/dl. The average cholesterol level in children whose mothers had high education levels was 125 +/- 16 mg/dl (m +/- sd), versus 161 +/- 21 mg/dl (m +/- sd); p = 0.005; (CI 95% of the difference 12 to 62 mg/dl) in children whose mothers had low-medium education levels. Cholesterol in children with family history of hypercholesterolemia (HC) showed a non-significant trend towards higher levels than in children without such antecedents (164 mg/dl vs 155 mg/dl; p = 0.19; NS). Neither the differences were significant when comparing children with or without family history of early cardiovascular disease (ECDV) (162 md/dl vs 158 md/dl; p = 0.49). Using both familiar antecedents as misleading method, just 72% of the children were diagnosed of HC (cholesterol greater than 175 md/dl). The absence of both antecedents (negative VP) would discard the presence of HC in 83% of the children in such situation (CI 95%, 67% to 92%).