[Elimination of measles plan in the Valencia community: epidemiological surveillance in 2003]. / Plan de eliminación del sarampión en la Comunidad Valenciana: vigilancia epidemiológica en el año 2003.

AIMS: Describing the clinical and epidemiological characteristics of the suspicions of measles notified in the CV during the year 2003 and evaluating the system of surveillance. DESIGN: Cross-sectional, descriptive study. SETTING: Community of Valencia (CV), Spain. PARTICIPANTS: Cases of suspected measles notified in 2003. MAIN MEASUREMENTS: Description of the data collected in the questionnaires (including names) of the Plan to Eliminate Measles of the CV, and obtaining of quality indicators for this plan and those proposed in the national action plan. RESULTS: From 43 notified suspicions, 11 (25.6%) were confirmed, 29 (67.4%) discarded, and 3 (7%) compatible. The rate of effect was 0.33 of 105. From 11 confirmed cases, 10 belonged to two outbreaks (one familiar and an other one communitary) and one was an isolated and imported case. 80% of areas of health were declared. The majority of the suspicions and all the cases were given in the first half of the year. Five cases were given in cohorts of age not submitted to the program of vaccination (minors of 15 months and major of 20 years), and 2 cases might have been avoidable in agreement with the program (6 and 12-year-old children not vaccinated). 40 samples of whey and 33 of urine were collect within the recommended periods. The majority of quality indicators were over the recommended ones (80%). CONCLUSIONS: In year 2003 no case of measles has taken place from autochthonous virus in the CV.

Plan de eliminación del sarampión en la Comunidad Valenciana: vigilancia epidemiológica en el año 2003 / Elimination of measles plan in the Valencia Community: epidemiological surveillance in 2003

Objetivo. Describir las características clínicas y epidemiológicas de los casos de sospecha de sarampión notificados en la Comunidad Valenciana durante el año 2003 y evaluar el sistema de vigilancia. Diseño. Estudio descriptivo, transversal. Emplazamiento. Comunidad Valenciana (CV). Participantes. Casos de sospecha de sarampión notificadas en 2003. Mediciones principales. Descripción de los datos recogidos en las encuestas nominales del Plan de Eliminación del Sarampión de la CV y obtención de indicadores de calidad de éste y los propuestos desde el plan de acción a escala nacional. Resultados. De 43 sospechas notificadas, se confirmó el 25,6%, se descartó el 67,4% y fue compatible el 7%. La tasa de incidencia fue de 0,33 por 105 habitantes. De los 11 casos confirmados, 10 correspondían a 2 brotes (uno familiar y otro comunitario) y uno fue un caso aislado e importado. El 80% de las áreas de salud notificó sospechas de sarampión. La mayoría de sospechas y casos se dio en la primera mitad del año. Cinco casos pertenecían a grupos de edad no incluidos en el programa de vacunación (menores de 15 meses y mayores de 20 años) y 2 casos podrían haberse evitado (niños de 6 y 12 años no vacunados). Se recogieron 40 muestras de suero y 33 de orina. La mayoría de los indicadores de calidad se cumplió por encima de los valores recomendados (80%). Conclusiones. Durante 2003 no se declaró ningún caso de sarampión por virus autóctonos en la CV

Aims. Describing the clinical and epidemiological characteristics of the suspicions of measles notified in the CV during the year 2003 and evaluating the system of surveillance. Design. Cross-sectional, descriptive study. Setting. Community of Valencia (CV), Spain. Participants. Cases of suspected measles notified in 2003. Main measurements. Description of the data collected in the questionnaires (including names) of the Plan to Eliminate Measles of the CV, and obtaining of quality indicators for this plan and those proposed in the national action plan. Results. From 43 notified suspicions, 11 (25.6%) were confirmed, 29 (67.4%) discarded, and 3 (7%) compatible. The rate of effect was 0.33 of 105. From 11 confirmed cases, 10 belonged to two outbreaks (one familiar and an other one communitary) and one was an isolated and imported case. 80% of areas of health were declared. The majority of the suspicions and all the cases were given in the first half of the year. Five cases were given in cohorts of age not submitted to the program of vaccination (minors of 15 months and major of 20 years), and 2 cases might have been avoidable in agreement with the program (6 and 12-year-old children not vaccinated). 40 samples of whey and 33 of urine were collect within the recommended periods. The majority of quality indicators were over the recommended ones (80%). Conclusions. In year 2003 no case of measles has taken place from autochthonous virus in the CV

Morbimortalidad hospitalaria en presos VIH+: diez años de cambios / In-hospital morbidity and mortality among hiv-positive prisioners: 10 years of changes

Objetivo: Establecer los cambios en la morbimortalidad hospitalaria causada por pacientes presos VIH en los diez últimos años.Diseño y Método: Estudio retrospectivo. Se incluyeron los presos VIH hospitalizados entre 01-01-1994 y 31-12-2003, período dividido en tres tramos que analizamos y comparamos: 01-01-94/31-12-97 (período sin TARGA), 01-01-98/31-12-01 (era TARGA) y 01-01-02/31-12-03 (TARGA más tratamientos anti-VHC). Se recogieron edad, sexo, UDVP, serología VHC, CD4+/μl al ingreso (±4 meses),diagnóstico hospitalario de Sida, de enfermedad relacionada con hepatopatía crónica por VHC, éxitus y duración de la hospitalización. Se hizo comparación de medias en variables cuantitativas y de proporciones en cualitativas, previo test de Levene para comprobar igualdad de varianzas. Con igualdad de varianzas hicimos test de ANOVA y estudio de tendencia lineal con contrastes ortogonales; sin esta igualdad, hicimos test de Kruskall-Wallis y la prueba de Jonckhere-Terpstra para el estudio de tendencia. Además, diseñamos un modelo de regresión de Poisson, ajustando la mortalidad por edad, sexo, días de hospitalización, período estudiado y diagnóstico hospitalario de Sida. Se utilizó el programa SPSS, versión 11.5.Resultados: Respectivamente, para cada uno de los períodos: los VIH+ causaron 163 hospitalizaciones de 258 totales (63,17%), 101/215 (46,23%) y 64/130 (49,23%) (p=0,003). Los pacientes eran mayoritariamente varones, UDVP y de edad progresivamente creciente: 30,14, 33,05 y 33,50 años de edad media (p<0,0001). La coinfección VIH-VHC era norma, el estado inmunológico mejoró: 170,4 CD4+, 280,8 y 330,1 (p<0,0001). Los diagnósticos de Sida disminuyeron: 64 (39% de los episodios de hospitalización), 18 (18%) y 7 (11%) (p<0,0001) y los relacionados con hepatopatía crónica aumentaron: 4 (2,5%), 12(11,9%), 13(20,3%) (p<0,0001). La estancia media disminuyó: 13,98 días vs 9,83 vs 7,35 (p<0,0001) así como los éxitus: 19 (11,7% de todos los episodios de hospitalización), 7 (6,9%) y 2 (3,1%), aunque sin alcanzar significación (p=0,093). En el modeloajustado la mortalidad desciende, pero no llega a valores significativos (p=0,073); encontramos doble riesgo de morir en los pacientes diagnosticados de Sida (RR=1,94, p=0,16).Conclusiones: El TARGA redujo las hospitalizaciones de los presos VIH+. La hepatopatía crónica por virus C está ganando peso como motivo de hospitalización entre los presos VIH+

Objective: Establish the changes in in-hospital morbidity and mortality caused by HIV prisoner patients over the last 10 years.Design and Method: Retrospective study. HIV prisoners hospitalised between 01-01-1994 and 31-12-2002 were recruited, this period was divided into three phases which were analysed and then compared: 01-01-94 / 31-12-97 (before HAART), 01-01-98 / 31-12-01 (HAART era) and 01-01-02 /31-12-03 (HAART and anti-HCV treatments). We included age, sex, IDU, HCV serology, CD4+/μl counts at imprisonment (+ 4 months), hospital diagnosis of AIDS and chronic hepatitis C virus, deaths and length of hospitalisation. We drew a comparison of means for quantitative variables and a comparison of proportionsfor qualitative variables. To prove equal variances we used the Levene test. In variables that reached equal variances, we carried out the ANOVA test and an analysis of linear trend with orthogonal contrasts; among the variables that didn’t reach equal variances, we carried out the comparison by means of the Kruskal-Wallis test. The non parametric Jonckhere-Terpstra (J-T) test was used to study the trend. We have also designed a Poisson regression model, adjusting mortality to age, sex, days of hospitalisations, period studied and hospital diagnosis of AIDS. The SPSS program (version 11.5) was used.Results: We have recorded 163 hospitalisations among HIV+ patients out of a total of 258 (which represented 63.17% of the total) in phase 0; 101 out of 215 (which represented 46.97% of the total) in phase 1 and 64 out of 130 (49.23% of the total) in phase 2 (p=0.003). Patients were a vast majority of men, IDUs and progressively older: 30.14; 33.05; 33.50 years old on average in each period respectively (p<0.0001). The HIV-HCV coinfection was usual but their immulogical state improved: 170.4 CD4+, 280.8 and 330.1 in each period respectively (p<0.0001). The AIDS diagnosis were reduced: 64 cases (which represented 39% ofhospitalisations), 18 (18%) and 7 (11%) in each period respectively. The chronic viral hepatitis diagnosis increased: 4 cases (which represented 2.5% of hospitalisations), 12 (11.9%) and 13 (20.3%) in each period respectively (p<0.0001). The mean length ofhospitalisation was reduced: we recorded 13.89 days, 9.83 and 7.55 in each period respectively (p=0.0001) as well as deaths: 19 (which represented 11.7% of the total of hospitalisations), 7 (6.9) and 2 (3.1%) in each period respectively. However no statistic significance was reached (p=0.093). In the multivariate model, the mortality rate is reduced, but doesn’t reach significative values (p=0.073). We found that patients diagnosed with AIDS have twice as much risk to die (RR=1.94; p=0.16).Conclusions: HAART reduced hospitalisations among HIV-positive prisoners. Chronic Hepatitis C virus has an increasing impact on hospital admissions among HIV-positive prisoners

Evolución de las resistencias a Mycobacterium tuberculosis en la provincia de Castellón. Años 1992-1998 / Evolution of resistant Mycobacterium tuberculosis in the province of Castellón (Spain): 1992 through 1998

Objetivos: Conocer la frecuencia de las resistencias a Mycobacterium tuberculosis y los factores de riesgo asociados a éstas en la provincia de Castellón. Material y métodos: Se ha realizado un estudio prospectivo de la sensibilidad a los tuberculostáticos, por el método de las proporciones de Canetti, de todas las cepas de M. tuberculosis aisladas en nuestra provincia (532) desde enero de 1992 a diciembre de 1998 (7 años), de las que 461 correspondían a casos nuevos. Resultados: Encontramos una tasa global de resistencias del 4,7 por ciento (25/532), de las cuales el 3,9 por ciento (18/461) fueron primarias y el 11,1 por ciento (7/63) secundarias. Por fármacos, el 3 por ciento eran resistentes a isoniacida, el 1,87 por ciento a rifampicina, el 1,87 por ciento a estreptomicina y el 0,56 por ciento a etambutol. La multirresistencia hallada ha sido del 0,2 por ciento (1/461) para los casos nuevos y del 1,1 por ciento (6/532) para el total. La presencia de resistencia de M. tuberculosis se asocia al antecedente de tratamiento antituberculoso previo (OR = 3,14; p = 0,017), y a la presencia de uno o más factores de riesgo para tuberculosis (OR = 3,32; p = 0,666). Conclusiones: La tasa global de resistencias de M. tuberculosis y la multirresistencia son bajas en la provincia de Castellón; sin embargo, se asocian a un aumento de la mortalidad, de manera que el control de algunos de estos factores de riesgo de tuberculosis prevenibles podría, tal vez, disminuir la frecuencia de resistencias. (AU)

Mutaciones asociadas a resistencia a fármacos antirretrovirales en una población penitenciaria "Naïve" / Mutations associated with resistance to antiretroviral medication in a previously untreated prison population

Objetivo: Determinar la existencia de mutaciones asociadas a resistencias a fármacos antirretrovirales en una población penitenciaria infectada por el VIH y sin tratamiento antirretroviral previo. Material y Método: Estudio descriptivo, transversal en el que se examinan genotipos del VIH procedentes de muestras plasmáticas de los pacientes VIH+ naives del C.P. de Castellón. Las muestras se analizan en el Instituto Valenciano de Microbiología de Bétera (Valencia) mediante doble amplificación por PCR y posterior secuenciación con secuenciador automático de Perkin-Elmer; secuencia de referencia: la cepa salvaje HXB2 del VIH. La proporción de mutantes existentes se expresan en porcentajes sobre el total de la muestra y el resto de los datos se procesan con el paquete estadístico Epiinfo 6.0. Resultados: De 25 muestras, en una no había material genético suficiente para amplificar. En las 24 restantes no se encuentran mutaciones de resistencia a INTI. 7 pacientes (32 por ciento), presentan mutaciones de resistencia a IP: 4 presentan la L63P, 2 la V77I y un paciente una mutación doble: L63P+V77I. Conclusiones: Nuestros resultados sugieren que en nuestro medio seguimos pudiendo instaurar tratamientos antirretrovirales en infectados naïves de forma empírica; no obstante la cortedad de la muestra y su focalización geográfica obligan a seguir realizando estudios de este tipo para confirmarlo (AU)

[Dermatitis outbreaks caused by Pyemotes]. / Brotes de dermatitis originados por Pyemotes.

BACKGROUND: We describe three outbreaks of pyemotes dermatitis. METHODS: We undertook case-control studies and samples of several suspected materials were taken. RESULTS: There were 126 cases, with no cases admitted in hospitals. Contact which suspected vegetable materials were the only risk factor identified. Among orange picker workers risk factor was the exposure to orange trees, where Pyemotes mite was found. CONCLUSION: To our knowledge this kind of occupational risk among orange pickers has not been described before.

Aspectos epidemiológicos de la resistenciade Escherichia coli a ciprofloxacinoen un hospital general / Epidemiological aspects of ciprofloxacin-resistant Escherichia coli in a general hospital

Se estudió retrospectivamente la sensibilidad de los aislamientos de Escherichia coli a ciprofloxacino en un hospital general durante cuatro años (1995-1998). Se recogieron datos referentes a edad, sexo, muestra, procedencia, fecha y sensibilidad de los pacientes con aislamiento de E. coli, utilizándose el estadístico c2 para la comparación de proporciones. Se identificaron 7288 aislamientos pertenecientes a 5667 pacientes, de los que 1003 presentaron un aislamiento resistente a ciprofloxacino (17,7 por ciento). La variación de la resistencia no fue estadísticamente significativa. Los aislamientos resistentes fueron significativamente más frecuentes en hombres, en muestras de orina y en pacientes no ingresados, y aumentaron con los diferentes grupos de edad. Para la población con aislamientos resistentes la edad media fue de 61,29 años (DE 21,56), siendo de 39,76 años (DE 27,41) para los pacientes con aislamientos sensibles (p <0.0001). El porcentaje de resistencias fue similar para los pacientes no ingresados procedentes de centros de salud o de consultas externas hospitalarias. Por servicios hospitalarios, los porcentajes de resistencia más altos se observaron en Urología, con un porcentaje de resistencia superior entre los pacientes de consultas externas (p <0.0001). La resistencia a otras fluoroquinolonas se mantuvo sin significación para norfloxacino y aumentó a partir de 1997 para pefloxacino, a costa de aislamientos que eran sensibles a ciprofloxacino (AU)

[Evolution of drug-resistant Mycobacterium tuberculosis in the province of Castellón. 1992-1998]. / Evolución de las resistencias a Mycobacterium tuberculosis en la provincia de Castellón. Años 1992-1998.

OBJECTIVES: To determine the frequency of resistant Mycobacterium tuberculosis and the risk factors associated with resistance in the province of Castellón (Spain). MATERIAL AND METHODS: This prospective study of M. tuberculosis sensitivity applied Canetti's method of proportions to all strains isolated in Castellón (n = 532) from January 1992 through December 1998 (7 years); 461 cases were new. RESULTS: The overall frequency of resistant strains was 4.7% (25/532), of which 3.9% (18/461) were instances of primary resistance and 11.1% (7/63) were of secondary resistance. Three percent were resistant to isoniazid, 1.87% to rifampicin, 1.87% to streptomycin and 0.56% to ethambutol. Multiple drug resistance was found in 0.2% (1/461) of the new cases and 1.1% (6/532) overall. The presence of resistant M. tuberculosis was associated with a history of antituberculous treatment (OR = 3.14; p = 0.017) and the presence of one or more risk factors for tuberculosis (OR = 3.32; p = 0.066). CONCLUSIONS: The overall rates of resistant M. tuberculosis and multiple drug resistance are low in the province of Castellón; however resistance is associated with higher mortality such that controlling some preventable risk factors might reduce the frequency of resistance.

[The short-term effects of air pollution on mortality: the results of the EMECAM project in Castellón, 1991-95. Estudio Multicéntrico Español sobre la Relación entre la Contaminación Atmosférica y la Mortalidad]. / Efectos a corto plazo de la contaminación atmosférica sobre la mortalidad: resultados del proyecto EMECAM en Castellón, 1991-95.

BACKGROUND: In the last decade several studies have found out an association between air pollution and mortality in levels below the standards allowed by regulations. Castellón is a small city (134,000 inhabitants) with low air pollution levels. This work aims to identify if there is a short term relation between these both variables in this city. METHODS: We used mortality data and air pollution data (black smoke and sulphur dioxide), from 1.991 to 1.995, doing an ecological study using a time series analysis with the day as unit of the analysis. Poisson regression allow us to get the relative risk adjusted by others variables (meteorological, trend, influenza, day of the week, season) in autoregresive models. RESULTS: Black smoke and SO2 daily means were respectively 34.6 and 15.7 micrograms/m3. Results showed a 3.6% (IC95 0.3-7.0) of SO2 and 3.5% (IC95% 0.5-6.5) increment of cardiovascular mortality for an increment of 10 micrograms/m3 of SO2 and black smoke respectively. Sulphur dioxide was positively associated with all four groups of mortality causes but only in cold season. CONCLUSION: Even in a small city with low air pollution levels, we found an association between air pollution and immediate mortality. In some cases, the analysis by periods (warm and cold) show an strong effect modification.

[Factors associated with sporadic cases of salmonellosis in 1- to 7-year-old children. Study of cases and controls]. / Factores asociados con casos esporádicos de salmonelosis en niños de 1 a 7 años. Estudio de casos y controles.

BACKGROUND: Knowledge about salmonellosis risk factors mainly comes from foodborne outbreaks, and we know little about sporadic cases epidemiology. However most of the cases are sporadic, specially children. This study aims to find out some of determinants of these cases. METHODS: A case-control study with incident cases and controls from the same base population (laboratory diagnosed cases). Cases were children 1-7 years old, affected by diarrhea with culture stools positive to Salmonella between december 1994 and december 1995. Controls from the same source, but positive culture to Campylobacter or viruses. We study food and other environmental risk factors. Odds ratio (OR) are calculated adjusted for age, sex, and year period (cool and cold) by logistic regression. RESULTS: Eating minced meat during three days before symptoms, OR 4.07 (1.20-13.8) and OR 5.63 (1.34-23.6); pets, OR 8.27 (1.96-34.9), and antibiotics the week before symptoms, OR 4.75 (0.84-27.0) were epidemiologically associated with salmonellosis diarrhea. CONCLUSIONS: Epidemiology of salmonellosis sporadic cases in children seems different to the foodborne associated cases and is more complex. Minced meat tree days before symptoms, antibiotics the week before symptoms, and pets could be a risk for this kind of cases. Future studies must also take account of this factors.

[Outbreak of Salmonella enteritidis food poisoning. Potential protective effect of alcoholic beverages]. / Brote de infección alimentaria por Salmonella enteritidis. Possible efecto protector de las bebidas alcohólicas.

BACKGROUND: On may 1994, a foodborne outbreak took place in Almazora (Castellón, Spain) after a meal with 116 persons. A sanitary study was made to find out the causes and control the outbreak. SUBJECTS AND METHODS: Inspection of the setting and a case-control study were carried out. Several foods and faecal specimens of 23 patients were investigated. We also study the effect of alcohol on the occurrence of the outbreak. RESULTS: A hundred people was interviewed (86%), 58 ill persons. Salmonella enteritidis was isolated from faeces and statistically implicated food (odds ratio = 75, IC 95 = 15.6-361), a sandwich with tuna, boiled eggs and vegetables. Among adults, epidemiological analysis showed a protective effect of alcohol, adjusted for age, sex and consumption of the implicated food (p = 0.007). CONCLUSIONS: In the study of foddborne outbreaks by Salmonella enteritidis simultaneous consumption of alcoholic drinks and foods should be taken into account to explain some exposed non-cases.

[Collective scombroid fish poisoning following tuna consumption in Castellon]. / Escombrointoxicación colectiva por consumo de atún en Castellón.

BACKGROUND: To investigate and control of a collective scombroid-fish poisoning (SFP) outbreak, that took place in Castellón, Spain. METHODS: Description of the outbreak and case-control study in order to identify risk factors. Active surveillance of SFP cases, and inspection of implicated markets. Histamine determination in urine of cases and foods. RESULTS: During June 1994, 15 cases of SFP were found out, with 12 cases occurred on June, 28 and 29. Five families were affected (attack rate 68.2%). The median incubation period was 45 minutes. Disease symptoms included facial or general flushing, headache, diarrhea, nausea, abdominal pain, and peppery taste. Implicated food was fresh tuna, bought in a hypermarket of Castellón (odds ratio = 26.4, 95% confidence intervals: 1.05-666.8), adjusted by age and sex using logistic regression analysis. Four samples of urine from cases presented histamine concentration above 35 micrograms/l. Three samples of tuna consumed by cases and one sample of tuna from the hypermarket had histamine concentration above a 200 ppm. Considering the situation of risk, remaining suspected tuna was confiscated from the hypermarket. Rest unknown if the descompositions of tuna occurred in the hypermarket or during capture and distribution. CONCLUSIONS: SFP was caused by fresh tuna ingestion with epidemiologic and analytic confirmation. Determination of histamine in urine of patients could permit to confirm SFP.

[Diffusion of hepatitis B among residents of an institution for handicapped children]. / Difusión de la hepatitis B entre los residentes de una institución para niños con minusavalías.

BACKGROUND: To estimate the prevalence of serologic markers of hepatitis B (SMHB) among residents of an institution for social or mental handicapped children in Castellón, and its association with risk factors. METHODS: A cross-sectional study with determination of SMHB by radioimmunoassay. 98 of the 100 residents participate in the study. RESULTS: Prevalence of SMHB was 24.5% (95% confidence interval: 16.4%-34.1%). Seven residents were hepatitis B surface antigen positive with three hepatitis B e antigen positive. SMHB prevalence was 0 in infants, 18.8% in toddlers, 24.5% in schoolchildren, 11.1% in special education, and 76.9% in permanent residents. Logistic regression analysis found associations of SMHB prevalence with age (Odds ratio [OR] = 5.8, 95% CI: 1.1-29.0), old age at admission with protective character (OR = 0.6, 95% CI: 0.4-0.8), and duration of stay (OR = 1.2 95% CI: 1.0-1.3), adjusting by sex, mental deficiency, and hepatitis B (HB) determinants like surgery, blood transfusion, odontology, bites, and injections. CONCLUSIONS: A predominant transmission of HB in young ages is suggested. Vaccination against HB, hygienic measures, and periodic serologic studies of HB are essential to prevent this disease.

[Leishmaniasis in Castellón: an epidemiological study of human cases, the vector and the canine reservoir]. / Leishmaniasis en Castellón: estudio epidemiológico de los casos humanos, vector y reservorio canino.

BACKGROUND: Incidence of human leishmaniasis in Castellón is among the highest in Spain. In order to know epidemiologic situation of leishmaniasis, human incidence, Phlebotomus' presence and canine reservoir were studied. METHODS: The study was carried out during 1989-1990, and included review of different registers of cases and glucantime use, Phlebotomus catching, and leishmaniasis serology (immunofluorescent test, IFT) of dogs from municipal kennel and rabies vaccine programme. RESULTS: Hospitals' underreporting visceral leishmaniasis was noted. Glucantime's distribution permitted identification of some no reported cases. 2267 sandflies were caught, which 196 were vectors: P. perniciosus (182), P. sergenti (6), P. papatasi (4) and P. ariasi (4). Dog's prevalence of leishmaniasis (IFT > or = 1/80) was 5.1% (CI 95%: 1.1-9.1) in dogs fron the municipal kennel, and 0% in dogs from the vaccine programme. CONCLUSIONS: Human leishmaniasis is hypoendemic in Castellón, with a low-middle rank in canine leishmaniasis. Entomologic results agree with other spanish studies. However, P. sergenti and P. ariasi were not described in Catellón until now. Leishmaniasis surveillance should be maintained.

[Prevalence of Hepatitis B serologic markers among the personnel of the institution for children with deficiencies]. / Prevalencia de marcadores serológicos de la hepatitis B en el personal de una institución para niños con minusvalías.

BACKGROUND: The risk of infection by the hepatitis B virus (HBV) in institutions for children with deficiencies has been established in several studies. The purpose of this work was to know the prevalence of HBV markers, among the employees in an institution of that kind, and its association with several risk factors. METHODS: A transveral epidemiologic survey has been carried out to determine the markers prevalence of infection by hepatitis B virus (HBV) and its association with certain risk factors, among the 200 workers of an institution for children with deficiencies. Determinations, by radioimmunoassay were: HBs Ag, anti-HBs and anti HBe. RESULTS: The participation was 95%, with a prevalence of any marker of 7.9% (IC95 + 4.1-11.7). No HBs Ag carriers were detected, taking occupation as an indicator variable with three categories: Trades and auxiliary health personnel versus teachers, the logistic regression analysis showed odds ratios, adjusted for age, sex and working time, for trades and auxiliary health personnel, respectively. CONCLUSIONS: Vaccination is the preventive recommendation for HBV in these institutions, because of the difficulty to find other factors associated to HBV. The possibility of introducing a universal vaccination is controversial.

[Familial outbreak of pneumonia by psittacosis]. / Brote familiar de neumonía por psitacosis.

A familial outbreak (4 cases) of pneumonia by psittacosis in Vall de Uxó (Castellón) during the month of April in 1990 is described. In addition to the epidemiologic, clinical and serologic (complement fixation) studies carried out a survey and serology of 11 healthy controls (neighbors, and employees from a bird shop) were performed. The serum of a parrot recently acquired by the patients (positive at 1/8) was analyzed. The habit of petting the animal was significantly associated with the disease. The patient's response to treatment was good. The titers of antibodies versus Chlamydia psittaci were higher than those of the controls examined and the established threshold for positivity (1/36). In addition to clinical intervention the roles of epidemiology and the participation of veterinary services are fundamental to control this disease the exact prevalence of which is unknown.

[Food poisoning outbreak probably of viral etiology caused by Norwalk virus]. / Brote de toxiinfección alimentaria de probable etiología vírica por virus Norwalk.

In May 1989, a foodborne outbreak of acute gastroenteritis was identified in a state school in Adzaneta, Castellón. A dtudy was undertaken to describe it, investigate its causes, and recommend adequate control measures. Sixteen children and 2 teachers were affected (attack rate: 28.57%). Kaplan and cols clinical and epidemiological criteria for Norwalk-like virus as the responsible agent were present. The probable origin of the outbreak was a foodhandler who was already ill beforehand. The examination of stools of the foodhandler and a patient showed small round structures similar to the Norwalk virus. In Spain, the number of foodborne outbreaks without known causal agent has steadily increased in recent years. It may be that this microorganism is responsible for some of these outbreaks in which, for several reasons, the causal agent cannot be identified.