Prevalencia y detección de las infecciones activas por el virus de la hepatitis C no diagnosticadas en Navarra, 2017-2019 / No disponible

ANTECEDENTES: las infecciones activas por el virus de la hepatitis C (VHC) no diagnosticadas son un obstáculo para avanzar en su eliminación. El objetivo fue estimar su prevalencia y describir los avances en su diagnóstico. MÉTODOS: se analizó la actividad diagnóstica de infecciones por VHC en Atención Primaria y especializada en Navarra entre 2017 y 2019. La prevalencia de infección no diagnosticada se estimó en pacientes con cirugía programada no relacionada con la infección por VHC, a los que se les realizó determinación rutinaria de anticuerpos del VHC (anti-VHC). En aquellos con anti-VHC positivo se determinó ARN-VHC. La prevalencia se estandarizó según sexo y edad de la población general. RESULTADOS: entre 63.405 pacientes estudiados para anti-VHC se diagnosticaron 84 infecciones activas (cinco por 100.000 personas-año). Atención Primaria analizó 20.363 pacientes y diagnosticó 47 infecciones activas, una por cada 433 personas analizadas, que supusieron el 56 % de todas las infecciones activas detectadas. Por otra parte, se analizaron 9.399 pacientes quirúrgicos y se detectaron 120 con anti-VHC (prevalencia ajustada: 1,47 %; intervalo de confianza [IC] del 95 %: 1,24-1,52); 66 (0,61 %) habían tenido carga viral positiva alguna vez y cinco eran infecciones activas no diagnosticadas (prevalencia ajustada: 0,04 %; IC 95 %: 0,01-0,11). El cribado prequirúrgico detectó una infección no diagnosticada por cada 795 personas analizadas de 45 a 64 años. CONCLUSIÓN: Atención Primaria está contribuyendo eficientemente a la detección de infecciones activas por VHC no diagnosticadas. Este objetivo podría acelerarse mediante un cribado poblacional dirigido a edades entre 45 y 64 años

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Prevalence and detection of undiagnosed active hepatitis C virus infections in Navarre, Spain, 2017-2019.

BACKGROUND: undiagnosed active hepatitis C virus (HCV) infection remains an obstacle towards its eradication. This study aimed to estimate the prevalence of HCV infection and to describe the diagnostic advances in Navarre, Spain. METHODS: HCV-infection diagnostic performance was analyzed in Navarre's primary and specialized health care between 2017 and 2019. The prevalence of undiagnosed infections was estimated for patients with programmed surgeries unrelated to HCV infection, who underwent a routine HCV antibody (anti-HCV) determination. HCV-RNA (viral load) was quantified in anti-HCV positive cases. The prevalence was standardized according to the sex and age distribution in the general population. RESULTS: from the 63,405 subjects examined for anti-HCV, 84 (five per 100,000 person-years) were diagnosed with an active infection. In Primary Health Care, 20,363 patients were analyzed and 47 active infections were detected, i.e. one case for every 433 people tested, implying 56 % of all identified active infections. On the other hand, 9,399 surgical patients were analyzed and 120 anti-HCV positive cases were detected (adjusted prevalence: 1.47 %; 95 % CI: 1.24-1.52). A positive viral load had been determined at any time in 66 cases (0.61 %), of which five were undiagnosed active infections (adjusted prevalence: 0.04 %; 95 % CI: 0.01-0.11). Preoperative screening allowed the detection of one undiagnosed infection per 795 people analyzed aged between 45 and 64 years. CONCLUSIONS: Primary Health Care efficiently contributes to the detection of undiagnosed HCV active infections. This may be speeded up by performing population screening, targeting subjects between 45 and 64 years of age.

Hepatitis C core antigen: Diagnosis and monitoring of patients infected with hepatitis C virus.

INTRODUCTION: New efficient strategies are needed for the assessment of active hepatitis C virus (HCV) infection. The aim of this study was to evaluate the ability of HCV core antigen (HCV-cAg) as a marker of active HCV infection in newly diagnosed patients, for treatment monitoring, and for the detection of therapeutic failure. MATERIALS AND METHODS: A prospective study was conducted at a regional reference hospital in Spain. HCV-cAg and viral load (RNA-HCV) were tested in plasma or serum samples from three patient groups: new diagnosis, treatment monitoring, and treatment failure. The treatment monitoring group was tested at the beginning of treatment, at 4 weeks post-initiation, at the end of treatment, and at 12 weeks post-treatment completion. The Architect HCV core antigen assay was performed for HCV-cAg testing, and viral load was quantified with the Cobas 6800 system. RESULTS: A total of 303 samples from 124 patients were analyzed. Excellent correlation was seen between HCV-cAg and HCV-RNA (R2=0.932). The optimal cut-off value was 3fmol/l in the receiver operating characteristics curve analysis, and the area under the curve was 0.987 (95% confidence interval 0.972-1.000). HCV-cAg sensitivity and specificity were 97% and 95%, respectively. Most diverging results were observed in the treatment follow-up group. CONCLUSIONS: HCV-cAg demonstrated good sensitivity and specificity as a marker for active HCV infection, new diagnosis, detection of antiviral therapeutic failure, and treatment monitoring.

Enfermedad de Weil autóctona: a propósito de un caso / Autochthonous Weil's disease: A case report

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Progress in the elimination of hepatitis C virus infection: A population-based cohort study in Spain.

BACKGROUND: The World Health Organization set targets to eliminate hepatitis C virus (HCV) infection through detection and treatment of all cases by 2030. This study aimed to describe the progress and difficulties in the elimination of HCV infection in Navarra, Spain. METHODS: Using electronic healthcare databases, we performed a population-based prospective cohort study to describe changes in the prevalence of diagnosed active HCV infection at the beginning of 2015 and the end of 2017, the rate of new diagnoses and the rate of post-treatment viral clearance (PTVC) during this period. RESULTS: At the beginning of 2015 there were 1503 patients diagnosed with positive HCV-RNA, 2.4 per 1000 inhabitants, and at the end of 2017 the prevalence had decreased by 47%. In the study period, 333 (18 per 100,000 person-years) new positive HCV-RNA cases were detected, but only 76 (23%; 4.2 per 100,000 person-years) did not have anti-HCV antibodies previously detected. Prevalent cases and new diagnoses of active infection were more frequent in men, people born in 1950-1979, HIV-infected patients and in those with lower income levels. Among patients with HCV-RNA, 984 achieved PTVC (22.7 per 100 person-years). PTVC was less frequent in patients born before 1940, in immigrants and in patients with lower income levels. CONCLUSIONS: The prevalence of diagnosed active HCV infection has dropped by almost half over three years, because the number of patients with PTVC was much higher than the number of new diagnoses. Interventions specifically targeted at population groups with less favourable trends may be necessary.

Estimación de la prevalencia de infección diagnosticada y no diagnosticada por el virus de la hepatitis C en Navarra, 2014-2016 / The prevalence of diagnosed and undiagnosed hepatitis C virus infection in Navarra, Spain, 2014-2016

OBJETIVO: Estimar la prevalencia de infección por el virus de la hepatitis C (VHC) en Navarra, distinguiendo entre infecciones diagnosticadas y no diagnosticadas. MÉTODOS: Se estudiaron pacientes con cirugía programada no relacionada con la infección por VHC, a los que se les realizó de forma sistemática la determinación de anticuerpos del VHC entre enero de 2014 y septiembre de 2016. En los pacientes con enzimoinmunoanálisis positivo se confirmó el diagnóstico mediante inmunoblot y/o determinación de ARN-VHC. También se comprobó la existencia de resultados positivos previos. La prevalencia se estandarizó por sexo y edad a la población de Navarra. RESULTADOS: Se analizaron 7.378 pacientes, 50% mujeres, con una mediana de edad de 46 años. En 69 se detectaron anticuerpos del VHC, lo que supone una prevalencia poblacional estimada de 0,83% (intervalo de confianza del 95%: 0,64-1,05), mayor en hombres (1,11%) que en mujeres (0,56%; p = 0,0102). Entre los que resultaron anti-VHC positivos, 67 (97%) habían tenido alguna prueba positiva previa. La prevalencia poblacional de diagnóstico previo de anti-VHC fue del 0,80%, y la de nuevos diagnósticos, del 0,03%. El 78% de los pacientes con anti-VHC positivo habían presentado alguna determinación de ARN-VHC detectable. Se estima que el 0,65% de la población había tenido ARN-VHC detectable y el 0,51% lo seguía teniendo en el momento del estudio. CONCLUSIÓN: Estos resultados revisan a la baja las estimaciones previas de prevalencia de infección por VHC. Una proporción mínima de las personas con anti-VHC permanecen sin diagnosticar, y solo una parte mantienen infección activa

OBJECTIVE: To estimate the prevalence of hepatitis C virus (HCV) infection in Navarra, Spain, as well as to distinguish between diagnosed and undiagnosed infections. METHODS: A study was conducted on patients scheduled for surgery unrelated to HCV infection. They were all tested for HCV antibodies, under a routine scheme, from January 2014 to September 2016. Patients with a positive result by enzyme immunoassay were confirmed using immunoblot and/or HCV-RNA. Previous laboratory results were also taken into account. The prevalence was adjusted to the sex and age structure of the Navarra population. RESULTS: The study included a total of 7,378 patients with a median age 46 years, of whom 50% women. HCV antibodies were detected in 69 patients, which is a prevalence in the population of 0.83% (95% confidence interval: 0.64-1.05), and was higher in men (1.11%) than in women (0.56%; P = .0102). Among the HCV positive patients, 67 (97%) had had another previous positive result. Population prevalence of previous positive HCV was 0.80%, and was 0.03% for a new diagnosis. Of the HCV positive patients, 78% had detectable HCV-RNA. It was estimated that 0.65% of the population had had detectable HCV-RNA, and 0.51% continued to have it when recruited into the study. CONCLUSION: Previous estimates of prevalence of HCV infection should be revised downwards. Only a small proportion of HCV positive patients remain undiagnosed, and only a small part have active infection

Detection of Respiratory Viruses in Deceased Persons, Spain, 2017.

During the 2016-17 influenza season in Spain, we tested specimens from 57 elderly deceased persons for respiratory viruses. Influenza viruses were detected in 18% of the specimens and any respiratory virus in 47%. Only 7% of participants had received a diagnosis of infection with the detected virus before death.

Interim effectiveness of trivalent influenza vaccine in a season dominated by lineage mismatched influenza B, northern Spain, 2017/18.

The 2017/18 interim estimate of trivalent influenza vaccine effectiveness (VE) was 39% (95% confidence interval: 20-54) in Navarre. Compared with individuals unvaccinated in the current and five previous seasons, VE against influenza B was 41% for current and any prior doses, 67% for current vaccination only, and 22% for any prior doses, and 43%, 51% and 54%, respectively against influenza A(H3N2). This suggests moderate VE despite predominance of lineage mismatched influenza B.

The prevalence of diagnosed and undiagnosed hepatitis C virus infection in Navarra, Spain, 2014-2016. / Estimación de la prevalencia de infección diagnosticada y no diagnosticada por el virus de la hepatitis C en Navarra, 2014-2016.

OBJECTIVE: To estimate the prevalence of hepatitis C virus (HCV) infection in Navarra, Spain, as well as to distinguish between diagnosed and undiagnosed infections. METHODS: A study was conducted on patients scheduled for surgery unrelated to HCV infection. They were all tested for HCV antibodies, under a routine scheme, from January 2014 to September 2016. Patients with a positive result by enzyme immunoassay were confirmed using immunoblot and/or HCV-RNA. Previous laboratory results were also taken into account. The prevalence was adjusted to the sex and age structure of the Navarra population. RESULTS: The study included a total of 7,378 patients with a median age 46 years, of whom 50% women. HCV antibodies were detected in 69 patients, which is a prevalence in the population of 0.83% (95% confidence interval: 0.64-1.05), and was higher in men (1.11%) than in women (0.56%; P=.0102). Among the HCV positive patients, 67 (97%) had had another previous positive result. Population prevalence of previous positive HCV was 0.80%, and was 0.03% for a new diagnosis. Of the HCV positive patients, 78% had detectable HCV-RNA. It was estimated that 0.65% of the population had had detectable HCV-RNA, and 0.51% continued to have it when recruited into the study. CONCLUSION: Previous estimates of prevalence of HCV infection should be revised downwards. Only a small proportion of HCV positive patients remain undiagnosed, and only a small part have active infection.

Combined effectiveness of prior and current season influenza vaccination in northern Spain: 2016/17 mid-season analysis.

The 2016/17 mid-season vaccine effectiveness estimate against influenza A(H3N2) was 15% (95% confidence interval: -11 to 35) in Navarre. Comparing to individuals unvaccinated in the current and four prior seasons, effectiveness was 24% for current and 3-4 prior doses, 61% for current and 1-2 prior doses, 42% for only current vaccination, and 58% for 3-4 prior doses. This suggests moderate effectiveness for different combinations of vaccination in the current and prior seasons.

Diarrea del viajero por Cyclospora cayetanensis / Cyclospora cayetanensis in a patient with traveller´s diarrhoea

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