The PHH-1V HIPRA vaccine: a new tool in the vaccination strategy against COVID-19.

OBJECTIVE: Vaccination against SARS-CoV-2 is essential to mitigate the personal, social and global impact of the coronavirus disease (COVID-19) as we move from a pandemic to an endemic phase. Vaccines are now required that offer broad, long-lasting immunological protection from infection in addition to protection from severe illness and hospitalisation. Here we present a review of the evidence base for a new COVID-19 vaccine, PHH-1V (Bimervax®; HIPRA HUMAN HEALTH S.L.U), and the results of an expert consensus. METHODS: The expert committee consisted of Spanish experts in medicine, family medicine, paediatrics, immunology, microbiology, nursing, and veterinary medicine. Consensus was achieved using a 4-phase process consisting of a face-to-face meeting during which the scientific evidence base was reviewed, an online questionnaire to elicit opinions on the value of PHH-1V, a second face-to-face update meeting to discuss the evolution of the epidemiological situation, vaccine programmes and the scientific evidence for PHH-1V and a final face-to-face meeting at which consensus was achieved. RESULTS: The experts agreed that PHH-1V constitutes a valuable novel vaccine for the development of vaccination programmes aimed towards protecting the population from SARS-CoV-2 infection and disease. Consensus was based on evidence of broad-spectrum efficacy against established and emerging SARS-CoV-2 variants, a potent immunological response, and a good safety profile. The physicochemical properties of the PHH-1V formulation facilitate handling and storage appropriate for global uptake. CONCLUSIONS: The physicochemical properties, formulation, immunogenicity and low reactogenic profile of PHH-1V confirm the appropriateness of this new COVID-19 vaccine.

Excess hospitalizations and mortality associated with seasonal influenza in Spain, 2008-2018.

BACKGROUND: Influenza may trigger complications, particularly in at-risk groups, potentially leading to hospitalization or death. However, due to lack of routine testing, influenza cases are infrequently coded with influenza-specific diagnosis. Statistical models using influenza activity as an explanatory variable can be used to estimate annual hospitalizations and deaths associated with influenza. Our study aimed to estimate the clinical and economic burden of severe influenza in Spain, considering such models. METHODS: The study comprised ten epidemic seasons (2008/2009-2017/2018) and used two approaches: (i) a direct method of estimating the seasonal influenza hospitalization, based on the number of National Health Service hospitalizations with influenza-specific International Classification of Diseases (ICD) codes (ICD-9: 487-488; ICD-10: J09-J11), as primary or secondary diagnosis; (ii) an indirect method of estimating excess hospitalizations and deaths using broader groups of ICD codes in time-series models, computed for six age groups and four groups of diagnoses: pneumonia or influenza (ICD-9: 480-488, 517.1; ICD-10: J09-J18), respiratory (ICD-9: 460-519; ICD-10: J00-J99), respiratory or cardiovascular (C&R, ICD-9: 390-459, 460-519; ICD-10: I00-I99, J00-J99), and all-cause. Means, excluding the H1N1pdm09 pandemic (2009/2010), are reported in this study. RESULTS: The mean number of hospitalizations with a diagnosis of influenza per season was 13,063, corresponding to 28.1 cases per 100,000 people. The mean direct annual cost of these hospitalizations was €45.7 million, of which 65.7% was generated by patients with comorbidities. Mean annual influenza-associated C&R hospitalizations were estimated at 34,894 (min: 16,546; max: 52,861), corresponding to 75.0 cases per 100,000 (95% confidence interval [CI]: 63.3-86.3) for all ages and 335.3 (95% CI: 293.2-377.5) in patients aged ≥ 65 years. We estimate 3.8 influenza-associated excess C&R hospitalizations for each hospitalization coded with an influenza-specific diagnosis in patients aged ≥ 65 years. The mean direct annual cost of the estimated excess C&R hospitalizations was €142.9 million for all ages and €115.9 million for patients aged ≥ 65 years. Mean annual influenza-associated all-cause mortality per 100,000 people was estimated at 27.7 for all ages. CONCLUSIONS: Results suggest a relevant under-detected burden of influenza mostly in the elderly population, but not neglectable in younger people.

Vaccination strategies against SARS-CoV-2: General impact on the development of the pandemic.

In this article, we will review the main vaccination strategies currently being implemented by the health authorities and analyze the main vaccines authorized by the EMA. As practical aspects of vaccination, we must make it clear that until collective immunity is reached, the preventive measures being implemented will have to be kept in place. In the words of the WHO Accelerator Project, There is no time to waste in the fight against COVID-19. No one is safe until everyone is safe.

Adequacy of antibiotic prophylaxis and incidence of surgical site infections in neck surgery.

Health care-related infections are frequent and among them surgical site infection (SSI) are the most frequent in hospitals. The objective was to evaluate the adequacy of antibiotic prophylaxis in patients undergoing neck surgery and its relationship with the incidence of surgical site infection (SSI). Prospective cohort study. The adequacy of antibiotic prophylaxis in patients undergoing neck surgery was evaluated. Antibiotic prophylaxis was considered adequate when it conformed to all items of the protocol (antibiotic used, time of administration, administration route, dose and duration). The cumulative incidence of SSI was calculated, and the relationship between SSI and antibiotic prophylaxis adequacy was determined using adjusted relative risk (RR). Antibiotic prophylaxis was administered in 63 patients and was adequate in 85.7% (95% CI 75.0-92.3) of them. The cumulative incidence of SSI was 6.4% (95% CI 3.4-11.8). There was no significant relationship between antibiotic prophylaxis inadequacy and the incidence of SSI (RR = 2.4, 95% CI 0.6-10.6). Adequacy of antibiotic prophylaxis was high and it did not affect the incidence of SSIs.

[High-dose trivalent influenza vaccine: safety and immunogenicity]. / Vacuna antigripal trivalente de alta dosis: seguridad e inmunogenicidad.

Adults aged 65 years or older suffer the most severe health effects of seasonal flu. Although the influenza vaccine is effective in preventing influenza virus infection and its complications, it is not as effective in the elderly due to age-associated immunosenescence phenomenon. Since 2009, a high-dose trivalent influenza vaccine has been approved in the United States for the immunization of people ≥ 65 years with an antigen concentration four times higher than the standard vaccine. Multiple clinical trials carried out over different seasons, and using different methodologies, have shown that the high-dose trivalent influenza vaccine is not only more effective, but it also has a similar safety profile and is more immunogenic than the standard dose vaccine in the prevention of flu and its complications in the elderly. This document reviews the current scientific evidence on the safety and immunogenicity of high-dose influenza vaccine in people aged 65 years and over, and includes information from randomized clinical trials, observational studies with data from real clinical practice, and systematic reviews, and meta-analysis.

[High-dose trivalent influenza vaccine. Efficacy and effectiveness]. / Vacuna antigripal trivalente de alta dosis. Eficacia y efectividad.

Seasonal influenza is a major public health problem, particularly in older people. Influenza vaccine is the most effective way to prevent influenza virus infection and its complications, but due to immunosenescence, older people do not respond efficiently to immunization. In 2009, a high-dose trivalent influenza vaccine (IIV3-HD), containing four times more antigen than the standard-dose vaccine, was approved in the United States for the immunization of people aged 65 years and over. Numerous clinical trials, carried out at different seasons and using different methodologies, have shown that the IIV3-HD vaccine is, as well as safe, more immunogenic and more effective than the standard-dose vaccine in preventing influenza virus infection and its complications in older people. This paper reviews the available evidence on the efficacy and effectiveness of the IIV3-HD influenza vaccine in the elderly, with information from randomized clinical trials, as well as observational studies of real-world clinical practice and in systematic reviews/meta-analyses.

[Evaluation of compliance with the antibiotic prophylaxis protocol in hysterectomy. Prospective cohort study]. / Evaluación de la adecuación al protocolo de profilaxis antibiótica en histerectomías. Estudio de cohortes prospectivo.

OBJECTIVE: Health care-related infections are a public health problem, among them surgical site infection (SSI) are the most frequent in hospitals. The objetive of this study was to assess the effect of the compliance to antibiotic prophylaxis protocol on the incidence of surgical site infection in hysterectomized patients. METHODS: A prospective cohort study was carried out between October 2009 and December 2018. The incidence of SSI was studied after a maximum period of 30 days from the moment of surgery. The degree of adequacy of antibiotic prophylaxis in hysterectomy and the effect of its inadequacy on the incidence of infection was evaluated using relative risk (RR) adjusted with a logistic regression model. RESULTS: A total of 1,025 interventions were studied in 1,022 women. The cumulative incidence of SSI was 2,1% (n = 22). The most frequent etiology of infection was Escherichia coli (23.1%) and Proteus mirabilis (23.1%). Antibiotic prophylaxis was indicated in 1,014 interventions (98.9%) being administered in 1,009 of them (99.5%). The adherence to the protocol was 92,5%. The main cause of non-compliance was the time of onset (40.9%), followed by the choice of the antibiotic (35.2%). The effect of inadequate prophylaxis on the incidence of infection was RR = 0.9; 95% CI 0.2-3.9; p> 0.05. CONCLUSIONS: The adequacy of antibiotic prophylaxis was very high, with a low incidence of surgical site infection. No association was found between adequacy of prophylaxis and incidence of infection in hysterectomy. The continuous improvement of epidemiological surveillance in gynecology should be emphasized.

Inpatient hospital fatality related to coding (ICD-9-CM) of the influenza diagnosis in Spain (2009-2015).

BACKGROUND: To analyze hospitalization episodes with an ICD-9 diagnosis code of influenza (codes 487 and 488) in any diagnostic position from 2009 to 2015 in the Spanish hospital surveillance system. METHODS: Information about age, length of stay in hospital, mortality, comorbidity with an influenza diagnosis code between 1 October 2009 and 30 September 2015 was obtained from the National Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos, CMBD). RESULTS: 52,884 hospital admissions were obtained. A total of 24,527 admissions corresponded to diagnoses ICD-9 code 487 (46.4%), and 28,357 (53.6%) corresponded to ICD-9 code 488. The global hospitalization rates were 8.7 and 10.6 per 100,000 people, respectively. Differences between the two diagnostic groups were found for each of the six analyzed seasons. The diagnostic ICD-9-CM 488, male gender, and high-risk patients classified by risk vaccination groups showed direct relationship with inpatient hospital death. CONCLUSIONS: Influenza diagnosis was present in a significant number of hospital admissions. The code used for diagnosis (ICD-9-CM 488), male sex, age groups and associated risk clinical conditions showed a direct relationship with inpatient hospital fatality.

[Hand hygiene compliance with hydroalcoholic solutions in medical students. Cross-sectional study]. / Adherencia a la higiene de manos con soluciones hidroalcohólicas en estudiantes de medicina. Estudio descriptivo transversal.

OBJECTIVE: To assess hand hygiene compliance covertly in medical students in a university teaching hospital. METHODS: Cross-sectional study. Hand hygiene compliance in medical students was assessed in the units of Neonatology, Paediatrics, Neurology and Orthopaedic surgery. The five moments were covertly observed so as the hand rub technique. Hand hygiene compliance was described with the compliance percentages of the five moments. RESULTS: We studied 456 opportunities of hand hygiene. Global compliance was 44.3%. The most registered unit was Orthopaedic surgery (59.6%). According to the different moments, global compliance was better "after touching a patient" (60.2%). The unit with the highest hand hygiene compliance was Neonatology (60%). Hand hygiene compliance was better in the different hospitalisation units (50%) than in the office rooms (33%) (P<0.05) and the mean duration of hand hygiene was 22 seconds. CONCLUSIONS: Most of the moments were registered in the unit of Orthopaedic surgery and the moment with the highest hand hygiene compliance was "after touching a patient". The most hand hygiene compliance percentage was observed in Neonatology. Hand hygiene compliance was moderate, and it could and must be improved.

Actitudes de los profesionales sanitarios en la implementación de las recomendaciones oficiales de vacunación antigripal / No disponible

Se ha realizado un estudio para conocer las actitudes de los profesionales sanitarios hacia la recomendación de la vacunación oficial de vacunación antigripal. Para llevar a cabo este estudio se utilizó el cuestionario validado y publicado en la Revista Española de Salud Pública; (CAPSVA) y se pasó a los profesionales sanitarios de las CCAA de Asturias y Canarias. El muestro realizado no fue probabilístico sino de tipo incidental y se recogió cuestionario de 288 profesionales de Asturias y 192 de Canarias. El cuestionario contiene variables socio-demográficas y también variables relacionadas con las indicaciones oficiales de vacunación frente a gripe y características de las vacunas, datos sobre eficacia, efectividad y seguridad y por últimos da-tos sobre la formación que profesionales tienen sobre vacunación. La participación en el estudio fue voluntaria y anónima, y no se proporcionó ningún incentivo por la participación, y contó con la autorización de todos los participantes y con la autorización previa del programa de vacunaciones de cada Consejería, así como con la aprobación del Comité de Ética de la Investigación del Principado de Asturias (ref 34/19). Dentro los principales resultados del estudio el 62,7% dicen haber recibido formación al respecto en vacuna, el 90% de los encuesta-dos considera que la estrategia vacunal seguida en su CCAA mejora el espectro de protección frente a la gripe. Y como aspecto a mejorar manifestaron la necesidad de mantener la formación en este campo tanto en médicos/as como enfermeras/os y farmacéuticos/as. En cuanto a las recomendaciones específicas de la vacunación antigripal, cabe destacar que las más valoradas han sido aquellas que recomiendan la vacunación antigripal a sus propios pacientes con un valor de 2,992 sobre 5, y que la recomendación va ligada al interés del paciente en este caso con un valor de 2,923 sobre 5. En conclusión, las mejoras en las vacunas antigripales, como las vacunas cuadrivalentes, son un factor más a tener en cuenta a la hora de mejorar las coberturas de vacunación antigripal, ya que se percibe como un valor añadido clave tanto en la población general como entre los profesionales sanitarios

A study has been carried out to know the attitudes of health professionals towards the recommendation of the official vaccination of influenza vaccination. To carry out this study, the questionnaire validated and published in the Revista Española de Salud Pública was used; (CAPSVA) and passed to the health professionals of the Autonomous Communities of Asturias and the Canary Islands. The sampling was not probabilistic but of an incidental type and a questionnaire was collected from 288 professionals from Asturias and 192 from the Canary Islands. The questionnaire contains sociodemographic variables and also variables related to the official indications of vaccination against influenza and characteristics of vaccines, data on efficacy, effectiveness and safety and for the latest data on the training that professionals have on vaccination. Participation in the study was voluntary and anonymous, and no incentive for participation was provided, and had the authorization of all participants and prior authorization of the vaccination program of each Ministry, as well as the approval of the Committee on Research Ethics of the Principality of Asturias (ref 34/19). Among the main results of the study, 62.7% say they have received training in this regard in a vaccine, 90% of respondents believe that the vaccine strategy followed in their Autonomous Community improves the spectrum of protection against influenza. And as an aspect to improve, they expressed the need to maintain training in this field in both doctors and nurses and pharmacists. Regarding the specific recommendations of influenza vaccination, it should be noted that the most valued have been those that recommend influenza vaccination to their own patients with a value of 2,992 out of 5, and that the recommendation is linked to the patient's interest in this case with a value of 2,923 out of 5. In conclusion, improvements in influenza vaccines, such as quadrivalent vaccines, are another factor to consider when improving influenza vaccination coverage, as it is perceived as an added value key both in the general population and among health professionals

Incidence of surgical wound infection in renal surgery. The effect of antibiotic prophylaxis appropriateness. A prospective cohort study. / Incidencia de infección de herida quirúrgica en cirugía renal. Efecto de la adecuación de la profilaxis antibiótica. Estudio de cohortes prospectivo.

OBJECTIVE: To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection. MATERIAL AND METHODS: We performed a prospective cohort study and assessed the overall compliance and each aspect of the antibiotic prophylaxis (start, administration route, antibiotic of choice, duration and dosage) and reported the compliance rates. The qualitative variables were compared with the chi-squared test, and the quantitative variables were compared with Student's t-test. We studied the effect of antibiotic prophylaxis compliance on the incidence of surgical wound infection in renal surgery, with the relative risk. RESULTS: The study included 266 patients, with an overall compliance rate of 90.6%. The major cause of noncompliance (3.8%) was the start of the prophylaxis, and the incidence rate of surgical wound infections was 3.4%. We found no relationship between antibiotic prophylaxis noncompliance and surgical wound infections (RR=0.26; 95%CI: 0.1-1.2; P>.05). Laparoscopic surgery had a lower incidence of surgical wound infections than open surgery (RR=0.10; 95%CI: 0.01-0.79). CONCLUSIONS: The antibiotic prophylaxis compliance was high. The incidence of surgical site infection was low, and there was no relationship between the incidence of surgical site infection and antibiotic prophylaxis compliance. The incidence of infection was lower in laparoscopic surgery.

Incidencia de infección de herida quirúrgica en cirugía renal. Efecto de la adecuación de la profilaxis antibiótica. Estudio de cohortes prospectivo / Incidence of surgical wound infection in renal surgery. The effect of antibiotic prophylaxis appropriateness. A prospective cohort study

Objetivo: Evaluar la adecuación a protocolo de la profilaxis antibiótica en pacientes intervenidos de cirugía renal y su efecto en la incidencia de infección de localización quirúrgica. Material y métodos: Se realizó un estudio prospectivo de cohortes. Se evaluó la adecuación global y de cada apartado de la profilaxis antibiótica (inicio, vía de administración, antibiótico de elección, duración y dosis). Se describieron los porcentajes de adecuación. Las variables cualitativas se han comparado con la prueba Chi2 y las cuantitativas con la prueba t-Student. Se ha estudiado el efecto de la adecuación de la profilaxis antibiótica, en la incidencia de infección de localización quirúrgica en la cirugía renal, con el riesgo relativo. Resultados: Se incluyeron 266 pacientes en el estudio. La adecuación global fue del 90,6%. La mayor causa de inadecuación fue el inicio de la profilaxis, con un 3,8%. La incidencia de infección de localización quirúrgica fue del 3,4%. No se encontró relación entre la inadecuación de la profilaxis antibiótica y la infección de localización quirúrgica (RR = 0,26; IC 95%: 0,1-1,2; p > 0,05). La cirugía laparoscópica tuvo menor incidencia de infección de localización quirúrgica que la cirugía abierta (RR = 0,10; IC 95%: 0,01-0,79). Conclusiones: La adecuación de la profilaxis antibiótica fue alta. La incidencia de infección de localización quirúrgica fue baja y no hubo relación entre la incidencia de infección de localización quirúrgica y la adecuación a la profilaxis antibiótica. La incidencia de infección fue menor en la cirugía laparoscópica

Objective: To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection. Material and methods: We performed a prospective cohort study and assessed the overall compliance and each aspect of the antibiotic prophylaxis (start, administration route, antibiotic of choice, duration and dosage) and reported the compliance rates. The qualitative variables were compared with the chi-squared test, and the quantitative variables were compared with Student's t-test. We studied the effect of antibiotic prophylaxis compliance on the incidence of surgical wound infection in renal surgery, with the relative risk. Results: The study included 266 patients, with an overall compliance rate of 90.6%. The major cause of noncompliance (3.8%) was the start of the prophylaxis, and the incidence rate of surgical wound infections was 3.4%. We found no relationship between antibiotic prophylaxis noncompliance and surgical wound infections (RR = 0.26; 95% CI: 0.1-1.2; P > .05). Laparoscopic surgery had a lower incidence of surgical wound infections than open surgery (RR = 0.10; 95% CI: 0.01-0.79). Conclusions: The antibiotic prophylaxis compliance was high. The incidence of surgical site infection was low, and there was no relationship between the incidence of surgical site infection and antibiotic prophylaxis compliance. The incidence of infection was lower in laparoscopic surgery

[Description of Influenza B in seasonal epidemics in Spain]. / Descripción de la gripe B en las epidemias estacionales de España.

OBJECTIVE: Seasonal influenza epidemics are a major public health concern. They are caused by the influenza A and B viruses; although the A virus is more prominent, influenza B virus infection causes a disease with similar characteristics. There are two phylogenetically distinct influenza B lineages (B/Victoria and B/Yamagata), only one of which is present in the trivalent vaccine formulated each season. METHODS: Epidemiological data from the Spanish Influenza Surveillance System for 2007 to 2017 were reviewed to establish the relative proportion of each type of virus and the characterization of the B lineages in relation to the composition of the trivalent vaccine. RESULTS: The median proportion of B (2007-2017) was 27.2% (0.7%-74.8%) vs. 16.3% (0.4%-98.6%) for A-H3 and 44.2% (0.1%-98.0%) for pandemic A-H1N1 (20092017). The B lineages co-circulated in 8/10 seasons and there was mismatch with the B vaccine strain in 4/10 seasons. The B virus was dominant in 2007/08 and 2012/13 throughout Spain. There was a combination of dominance/codominance of influenza B and mismatch with the vaccine lineage in at least one third of epidemic seasons reviewed. CONCLUSIONS: Epidemiological information on influenza B has been less compiled in comparison with data on the A virus. Influenza virus type B is responsible for a significant number of cases in almost all seasons. The predominant B lineage in each season is unpredictable, affecting the protection conferred by the seasonal vaccine. Spanish epidemiological data support the rationale for a quadrivalent vaccine with both B virus lineages similarly to data from other settings.

Short-term association between outdoor air pollution and osteoporotic hip fracture.

This study examines the association of the levels of different airborne pollutants on the incidence of osteoporotic hip fracture in a southern European region. Association was detected between SO2 and NO2 and hospital admissions due to hip fracture. INTRODUCTION: To examine the short-term effects of outdoor air pollution on the incidence of osteoporotic hip fracture in a southern European region. METHODS: This is an ecological retrospective cohort study based on data obtained from three databases. In a time-series analysis, we examined the association between hip fracture incidence and different outdoor air pollutants (sulfur dioxide (SO2), monoxide (NO), nitrogen dioxide (NO2), ozone (O3), and particulate matter in suspension < 2.5 (PM2.5) and < 10-µm (PM10) conditions by using general additive models (Poisson distribution). The incidence rate ratio (IRR), crude and adjusted by season and different weather conditions, was estimated for all parameters. Hip incidence was later analyzed by sex and age (under or over age 75) subgroups. The main outcome measure was daily hospital admissions due to fracture. RESULTS: Hip fracture incidence showed association with SO2 (IRR 1.11 (95% CI 1.04-1.18)), NO (IRR 1.01 (95% CI 1.01-1.02)), and NO2 (IRR 1.02 (95% CI 1.01-1.04)). For O3 levels, this association was negative (IRR 0.97 (95% CI 0.95-0.99)). The association persisted for SO2 and NO2 when the models were adjusted by season. After adjusting by season and weather conditions, the association persisted for NO2. When participants were stratified by age and sex, associations persisted only in women older than 75 years. CONCLUSIONS: A short-term association was observed with several indicators of air pollution on hip fracture incidence. This is the first study that shows these associations.

[Prophylactic antibiotherapy in hip arthroplasty. Cohort study]. / Antibioterapia profiláctica en la artroplastia de cadera. Estudio de cohortes.

OBJECTIVE: The surgical site infection is the main cause of nosocomial infection in surgical patients, being antibiotic prophylaxis one of the most important factors for preventing it. This study evaluates adequacy of antibiotic prophylaxis in hip arthroplasty surgery as well as its effect on preventing surgical site infection. METHODS: A prospective cohort study was carried out from January 2011 to December 2016. We assessed the degree of adequacy of antibiotic prophylaxis in hip arthroplasty. Incidence of surgical site infection was studied after a maximum incubation period of 90 days. In order to assess the effect of inadequate prophylaxis on surgical site infection we used the relative risk adjusted with a logistic regression model. RESULTS: We studied 681 patients. Incidence of surgical site infection was 4% (95% CI 2.5-5.5). Antibiotic prophylaxis was administered in 99% of cases, with an overall protocol adequacy of 74%. The main cause of non-compliance was the length of prescription (22.2%; 149 patients). The effect of inadequate prophylaxis on surgical site infection was RRadjusted=0.47; 95%CI 0.19-1.17, (p>0.05). CONCLUSIONS: Adequacy of antibiotic prophylaxis was high. No relationship between prophylaxis adequacy and incidence of surgical site infection was founded. Surveillance allows us to assess surgical site infection and risk factors.

Effectiveness of acellular pertussis vaccine and evolution of pertussis incidence in the community of Madrid from 1998 to 2015.

INTRODUCTION: Pertussis is a communicable disease that primarily affects infants. Vaccination has led to an important reduction in the incidence of the disease, however, resurgence of the disease has been observed. This study aimed to analyze the incidence of pertussis and assess the vaccination effectiveness (VE) of different schedules of acellular pertussis vaccination in the community of Madrid. METHODS: Pertussis cases notified to the Mandatory Disease Reporting System from 1998 to 2015 were analyzed. Five comparison periods were created: 1998-2001 (reference), 2002-2005, 2006-2009, 2010-2012 and 2013-2015. The incidence ratio (IR) between inter-epidemic periods was analyzed using a Poisson regression. VE was calculated using the screening method. Vaccine status data were collected from the vaccine registry. RESULTS: In total, 3855 cases were notified. Inter-epidemic periods were observed every 3-4 years. The incidence increased (IR: 5.99, p < 0.05) in the 2013-2015 period, particularly among infants younger than 1 month (IR: 32.41, p < 0.05). Vaccination data were available in 89% of cases. For those receiving the last dose at ≤6-month VE was 89.9% (95% confidence interval (CI): 87.3-92.0) after one year of follow-up, and 85.5% (95% CI: 82.4-88.1) after 11 years of follow-up. For those receiving the last dose at 18-months VE decreased from 98.8% (95% CI: 98.3-99.1) to 85.1% (95% CI: 81.9-87.7) in the same period, and for those receiving the last dose at 4-year VE decreased from 99.6% (95% CI: 99.3-99.7) to 79.3% (95% CI: 74.6-83.1). CONCLUSIONS: B. pertussis is circulating in our population, as shown by the epidemic peaks and increased incidence of pertussis in recent years. VE increased with the number of doses and decreased with the follow-up period. The effect of this and other vaccination strategies must be monitored to control the disease.

Effectiveness of different vaccine schedules for heptavalent and 13-valent conjugate vaccines against pneumococcal disease in the Community of Madrid.

INTRODUCTION: The heptavalent pneumococcal conjugate vaccine (PCV-7) was added to the childhood routine vaccination program in the Community of Madrid in November of 2006 with 3+1 recommended doses and a catch-up for those under 2years old. In June 2010, PCV-7 was replaced by 13-valent vaccine (PCV-13) with 2+1 recommended doses. In July of 2012, the PCV-13 was removed from the funded program and reintroduced again (2+1 recommended doses) in December 2014. In between, children were vaccinated privately with 3+1 recommended doses of PCV-13. The aim of this study was to evaluate the effectiveness of each vaccination schedule used in the Community of Madrid. METHODS: We included all cases of invasive pneumococcal disease (IPD) reported between 2007 and 2015 to the Notifiable Diseases Surveillance System. Vaccination information was obtained from the Immunization Registry. Vaccine effectiveness (VE) was estimated using the indirect cohort design for cases with serotype information. RESULTS: A total 779 cases were included in the study. Among them 47.6% of the cases were primo-vaccinated with booster, 20% primo-vaccinated, 15.9% incompletely primo-vaccinated and 16.5% not vaccinated. The VE for ≥1 doses of any PCV was 82% (CI 95%: 67.8-89.9%): 91.9% (CI 95%: 76.5-97.2%) for PCV-7 and 77.2% (48.6-89.9%) for PCV-13. VE in those receiving the full 2+1 or 3+1 schedules was 100% for both vaccines. CONCLUSIONS: A high number of vaccine failures were reported in children before they had the opportunity to receive the booster dose, especially due to PCV-13-non-PCV-7 serotypes. VE was higher for PCV-7 compared to PCV-13, except for those that received the complete schedule with booster that achieved 100% of VE, which shows the relevance of the vaccines and complying with all doses scheduled.

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011.

BACKGROUND AND OBJECTIVE: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. METHODS: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. RESULTS: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. CONCLUSIONS: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

Clinical profile of patients with severe anaphylaxis hospitalized in the Spanish Hospital System: 1997-2011

Background: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. Methods: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. Results: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. Conclusions: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis (AU)

Antecedentes: Los estudios que recogen datos sobre comorbilidades que empeoran la gravedad de la anafilaxia, carecen de un acercamiento exhaustivo. Objetivo: Usando la puntuación de Elixhauser (un sistema de puntuación asociado con mayor estancia hospitalaria, mayor gasto hospitalario y muerte), establecimos que comorbilidades fueron asociadas con anafilaxia grave. Métodos: Usamos para el estudio la base de datos de altas hospitalarias del Ministerio Español de Sanidad, entre 1997 a 2011. Se obtuvo varios modelos de regresión logística, en las cuales las variables dependientes fueron desenlaces relacionados con eventos asociados habitualmente a una gran gravedad de los episodios (muerte, parada cardio-respiratoria, necesidad de uso de ventilación mecánica invasiva o medicamentos vaso-presores, ingreso en la Unidad de Cuidados Intensivos y duración de la estancia) y las variables independientes fueron las 30 comorbilidades que comprenden la puntuación Elixhauser, junto con edad, sexo y las grandes causas de anafilaxia. Resultados: Encontramos que un mayor riesgo para anafilaxia grave estuvo asociado (3 o más regresiones logísticas con significación estadística) con una edad de más de 50 años, o haber experimentado arritmias cardiacas, alteraciones de la coagulación, disbalance hidro-electrolítico, enfermedad pulmonar crónica o anafilaxia por Echinococcus. Así mismo, en un análisis ajustado, una puntuación mayor del sistema Elixhauser se asoció con la mayoría de las variables de desenlace usadas para analizar la gravedad de la anafilaxia. Conclusiones: Enfermedades cardio-vasculares y respiratorias incrementan la gravedad de la anafilaxia y un mal estado de salud (representado por mayores puntuaciones del Sistema de puntuación de Elixhauser) se asocian con mayor gravedad de la anafilaxia (AU)