ABSTRACT
OBJETIVO: Valorar los resultados obtenidos por una red de vigilancia epidemiológica y asistencial de arbovirosis compuesta por médicos y profesionales de enfermería de hospital y atención primaria (AP) formados en su identificación, confirmación diagnóstica y manejo clínico. Emplazamiento: Zona Sanitaria Metropolitana Norte de Barcelona (1.400.000 habitantes; Cataluña, España) durante un año natural. PARTICIPANTES: Diecisiete médicos (7 de AP y 10 hospitalarios) más 4 enfermeros/as de AP. Tipo de estudio: Estudio observacional prospectivo. Mediciones principales: Se definieron variables demográficas, epidemiológicas (caso autóctono/importado, sospechoso/probable/confirmado) y asistenciales (síntomas, perfil serológico, periodo virémico). RESULTADOS: De los 34 pacientes identificados cumplían criterios de estudio 26 (76,5%) casos; de ellos, se confirmó alguna arbovirosis en 14 (53,8%): 13 fiebres dengues más 1 chikungunya. No se registraron casos de fiebre de zika. Existían antecedentes de viaje a zonas endémicas (23; 88,4%), pero no en 3 casos (11,6%), en los que se consideró la posibilidad de una transmisión autóctona; de ellos, se confirmó un caso de dengue. La incidencia estimada de arbovirosis fue de 0,4 (IC 95%: 0,33-0,51) casos × 10.000 hab./año, que, comparada con la incidencia estimada en la misma área geográfica durante el periodo 2009-2013 (0,19 casos ×10.000hab./año; IC 95%: 0,07-0,31), mostró un incremento significativo (p = 0,044). Los pacientes en periodo de viremia al momento de la primera visita médica fueron 11 (42,3%). CONCLUSIONES: Un programa de vigilancia epidemiológica intensificada definido a nivel de AP y hospitalario es capaz de detectar significativamente más casos de arbovirosis importadas y transmitidas autóctonamente. Posiblemente asistimos a un aumento en la incidencia de arbovirosis importadas, por lo que las medidas encaminadas a su identificación y confirmación deben reforzarse
OBJECTIVE: To evaluate the results obtained by a surveillance network on arbovirosis composed by doctors and nurses located at hospitals and Primary Care trained in their identification, diagnostic confirmation and clinical management. LOCATION: North Metropolitan Area of Barcelona (1,400,000 inhabitants; Catalonia; Spain) during a calendar year. PARTICIPANTS: Seven Primary Care and 10 hospital physicians plus 4 Primary Care nurses. Type of study: A prospective observational study. MAIN MEASUREMENTS: Demographic, epidemiological (autochthonous/imported, suspect/probable/confirmed case) and healthcare variables (symptoms, serological profile, viral period) were defined. RESULTS: Of the 34 patients identified, 26 (76.5%) met study criteria. Among them, any arbovirosis was confirmed in 14 (53.8%): 13 dengue plus 1 chikungunya fever. There were no cases of Zika fever. There was a history of travel to endemic areas 23 (88.4%), but not in 3 cases (11.6%) in which the possibility of an indigenous transmission was considered; of them, a case of dengue was confirmed. The estimated incidence of arbovirosis was 0.4 (95% CI: 0.33-0.51) cases × 10,000 hab/year which, when compared to the estimated incidence in the same geographical area during the period 2009-2013 (0.19 cases × 10,000 hab/year; 95% CI: 0.07-0.31), a significant increase was found (P = .044). Patients within viremia period at the time of their first medical visit were 11 (42.3%). CONCLUSIONS: An intensified epidemiological surveillance program defined at Primary Care and hospital levels is able to detect significantly more cases of imported and autochthonous arbovirosis. Possibly we are witnessing an increase in the incidence of imported arbovirosis and, thus, measures aimed at their identification and confirmation should be reinforced
Subject(s)
Humans , Male , Female , Young Adult , Adult , Epidemiological Monitoring , Arbovirus Infections/epidemiology , Arbovirus Infections/diagnosis , Primary Health Care , Prospective Studies , Arbovirus Infections/therapy , Dengue/diagnosis , Dengue/epidemiology , Dengue/therapy , Polymerase Chain Reaction , Spain/epidemiologyABSTRACT
OBJECTIVE: To evaluate the results obtained by a surveillance network on arbovirosis composed by doctors and nurses located at hospitals and Primary Care trained in their identification, diagnostic confirmation and clinical management. LOCATION: North Metropolitan Area of Barcelona (1,400,000 inhabitants; Catalonia; Spain) during a calendar year. PARTICIPANTS: Seven Primary Care and 10 hospital physicians plus 4 Primary Care nurses. TYPE OF STUDY: A prospective observational study. MAIN MEASUREMENTS: Demographic, epidemiological (autochthonous/imported, suspect/probable/confirmed case) and healthcare variables (symptoms, serological profile, viral period) were defined. RESULTS: Of the 34 patients identified, 26 (76.5%) met study criteria. Among them, any arbovirosis was confirmed in 14 (53.8%): 13 dengue plus 1chikungunya fever. There were no cases of Zika fever. There was a history of travel to endemic areas 23 (88.4%), but not in 3cases (11.6%) in which the possibility of an indigenous transmission was considered; of them, a case of dengue was confirmed. The estimated incidence of arbovirosis was 0.4 (95%CI: 0.33-0.51) cases ×10,000hab/year which, when compared to the estimated incidence in the same geographical area during the period 2009-2013 (0.19cases ×10,000hab/year; 95%CI: 0.07-0.31), a significant increase was found (P=.044). Patients within viremia period at the time of their first medical visit were 11 (42.3%). CONCLUSIONS: An intensified epidemiological surveillance program defined at Primary Care and hospital levels is able to detect significantly more cases of imported and autochthonous arbovirosis. Possibly we are witnessing an increase in the incidence of imported arbovirosis and, thus, measures aimed at their identification and confirmation should be reinforced.
