Effect of PTPN22, FAS/FASL, IL2RA and CTLA4 genetic polymorphisms on the risk of developing alopecia areata: A systematic review of the literature and meta-analysis.

OBJECTIVES: Genetic association studies on alopecia areata (AA) performed in various populations have shown heterogeneous results. The aim of the current review was to synthesize the results of said studies to estimate the impact of FAS, FASL, PTPN22, CTLA4 and IL2RA gene polymorphisms on AA susceptibility. DESIGN: A systematic literature search was conducted in the Medline, Web of Science, Scopus, EMBASE and LILACS databases. Studies published up to June 2020 were included. The results available in the grey literature including the Open Grey and Google Scholar databases were also used. The texts of potentially related studies were screened by individual reviewers. Evidence of publication bias was assessed using the Newcastle-Ottawa scale and the quality of evidence was assessed using the GRADE system. The quantitative synthesis was performed using the fixed effect model. RESULTS: Out of 1784 articles, we identified 18 relevant articles for the qualitative synthesis and 16 for the quantitative synthesis. In a study of rs2476601 polymorphism of PTPN22 gene, including 1292 cases and 1832 controls, a correlation was found with the risk of developing AA in the allelic model (OR1.49 [95% C:1.13-1.95]), the heterozygous codominant (OR1.44 [95% CI:1:19-1.76]) and dominant model (OR1.43 [95% CI:1.18-1.73]). No association was found between the presence of FASL, PTPN22, CTLA and IL2RA gene polymorphisms with AA susceptibility. CONCLUSIONS: The results suggest that the T allele of the single nucleoid polymorphism (SNP) rs2476601 in PTPN22 gene is a risk factor for developing alopecia areata. However, more robust studies defining the ethnic background of the population of origin are required, so that the risk identified in the present study can be validated. Additionally, a greater number of studies is necessary to evaluate the role of the FAS, FASL, PTPN22, CTLA4 and IL2RA genetic variants, given the heterogenous results found in the literature.

Coverage of human papillomavirus vaccination during the first year of its introduction in Spain.

The decision to introduce human papillomavirus (HPV) vaccination into the national immunisation programme in Spain was made in October 2007, recommending vaccination of girls aged between 11 and 14 years with three doses of HPV vaccine. All 19 regions of the country (17 Autonomous Communities and two Autonomous Cities) introduced HPV vaccination gradually into their immunisation programmes between November 2007 and the last school term of 2008. Eight regions administered the vaccine in healthcare centres and 11 in schools. In the first year of the introduction of HPV vaccination, coverage of the first and third doses was assessed, to determine the proportion of girls who did not complete the vaccination. On the basis of the available data, the Ministry of Health estimated that coverage for the first dose was 87.2% (range: 73.9­98.9%; 95% CI: 71.8 to 100) and 77.3% (range: 62.2­97.4%; 95% CI: 57.9 to 96.7) for the third dose. Higher uptake was observed when the vaccination was carried out in schools compared with healthcare centres, but the difference was not statistically significant. Negative messages in the media during implementation of the HPV vaccination programme may have had some influence on the attitudes of adolescent girls and/or their parents towards HPV vaccination and may be partly responsible for the observed vaccination dropout rate.

[Chickenpox outbreak in Herrera del Duque, Badajoz, Spain]. / Brote de varicela en Herrera del Duque (Badajoz).

INTRODUCTION: Chickenpox is a worldwide disease with high morbidity but few complications, although complications can be sevre in immunocompromised individuals and healthy adults. The annual chickenpox rate declared to the National Notification Disease Surveillance System is approximately 5 cases per 1,000 inhabitants in Extremadura (Spain). The aim of this study was to identify and describe the characteristics and cost of an epidemic outbreak of chickenpox in Extremadura. METHODS: Between November 2000 and March 2001, a descriptive study was performed. Cases of chickenpox were actively sought in a cohort of schoolchildren in Herrera del Duque (Badajoz). The protocols of the Monitoring Network of the Autonomous Community of Extremadura was used for case definition. Microbiological confirmation was performed by isolation of the virus and the presence of IgM and IgG markers in serum. We analyzed the direct and indirect tangible costs as well as the intangible costs of the outbreak. RESULTS: Seventy-five cases were identified, of which 94.7% occurred in children aged between 1-9 years, mainly boys. The attack rate was 18.5 cases per 1,000 inhabitants and 68.2% occurred in children aged less than 10 years charing a home. The clinical course was benign, without hospital admissions or complications. A total of 71.6% of children aged between 3 and 8 years were susceptible. A possible temporary aggregation of cases in the school was analyzed and a relative risk of 5.01 (p < 0.0001) was obtained. The virus was isolated in the 4 vesicle samples studied and serology was positive (IgM) in the 9 serum samples studied. The total cost of the outbreak was of 927,21 e, with a mean of 12,53 e per case and 205 school days lost. CONCLUSION: A chickenpox outbreack was confirmed in Herrera del Duque, with person-to-person transmission, affecting children aged between 1 and 9 years. The high susceptibility of the pupils, the characteristics of teaching, and the meetings prior to the carnivals played a determining role in the transmission of the epidemic. The estimated cost of this outbreak was 76% less than the cost that would have been generated by single-dose vaccination of the 75 individuals who contracted the disease.

Brote de varicela en Herrera del Duque (Badajoz) / Chickenpox outbreak in Herrera del Duque, Badajoz, Spain

Introducción: La varicela es una enfermedad de distribución mundial con una elevada morbilidad y pocas complicaciones, aunque puede presentar cuadros clínicos graves en inmunodeprimidos y adultos sanos. El objeto de este estudio es identificar y describir las características y los costes de un brote epidémico en Extremadura, cuya tasa anual de casos declarados al sistema de Enfermedades de Declaración Obligatoria (EDO) oscila en alrededor de 5 por 1.000 habitantes. Métodos: Estudio descriptivo con búsqueda activa de casos entre los meses de noviembre del año 2000 y marzo de 2001, y de la susceptibilidad de la cohorte escolarizada del colegio de Herrera del Duque (Badajoz). Las definiciones de casos fueron recogidas de los protocolos de la Red de Vigilancia de la comunidad extremeña. La confirmación microbiológica se realizó por aislamiento del virus y por presencia de marcadores IgM e IgG en el suero del enfermo. Se analizaron los costes tangibles directos e indirectos y los no tangibles del brote. Resultados: De los 75 casos identificados, 71 (94,7 por ciento) eran niños de entre uno y 9 años, predominando el sexo masculino. La tasa de ataque fue de 18,5 casos por 1.000 habitantes, y del 68,2 por ciento en convivientes menores de 10 años. La evolución fue benigna, sin ingresos hospitalarios ni complicaciones. Se encontró un 71,6 por ciento de niños susceptibles en los de entre 3 y 8 años. Se analizó una posible agregación temporal de casos en el colegio, obteniéndose un riesgo relativo (RR) de 5,01 (p < 0,001). Se aisló el virus en las 4 muestras de vesículas estudiadas y la serología (IgM) fue positiva en los 9 sueros estudiados. El coste total de brote fue de 927,21 e, con una media de 12,53 e por caso, y 205 días de pérdida escolar. Conclusión: Se confirmó la existencia de un brote de varicela en el colegio de la localidad de Herrera del Duque, con transmisión persona a persona, que afectó a niños de entre uno y 9 años. La elevada susceptibilidad del alumnado, las características de la docencia y las reuniones previas a los carnavales tuvieron un papel determinante en la propagación de la epidemia. El coste estimado para este brote se corresponde con un gasto un 76 por ciento menor del producido por la vacunación con una dosis de los 75 casos de este brote (AU)

Evaluation of the measles, mumps and rubella immunisation programme in Spain by using a sero-epidemiological survey.

In Spain, measles, mumps and rubella vaccination was introduced in 1981, with one dose at the age of 15 months and another at the age of 11 years being administered since 1995. Reported disease incidence was less than one case per 100,000 people for measles and rubella, and 23 cases per 100,000 people for mumps. A seroepidemiological survey was undertaken to estimate the frequency of susceptible individuals by age and environment; and vaccination coverage and efficacy of the vaccines administered. A population-based cross-sectional study was then conducted, covering the population aged 2-39 years, residing in Spain (excluding Catalonia). The sample was stratified by age and rural/ urban environment and informed consent obtained to take blood specimens from subjects attending blood-extraction centres. The final sample totalled 3,932 persons. IgG antibodies were detected by an enzyme-linked immunosorbent assay. Estimated vaccination coverage was 96% for children aged 2-5 years; vaccine efficacies were 96.7% for measles, 97.2% for rubella and 79.3% for mumps. Immunity was the lowest in the 6-9 year age group for measles (90.8%) and in males aged between 15 and 24 years for rubella (86 and 89.8%, respectively). In the case of mumps, this proved the lowest in the 2-5 year age group (76.7%) and in those autonomous regions in which only the Rubini strain had been administered. The incidence of measles has enabled the National Measles Elimination Plan to be implemented by which the elimination of congenital rubella syndrome could now be initiated. A possible explanation for the higher susceptibility observed for mumps might lie in the Rubini strain's low efficacy.

Age-specific seroprevalence of poliomyelitis, diphtheria and tetanus antibodies in Spain.

In 1996, a seroepidemiological study was undertaken in Spain, with the main aim of estimating the population's immunity against poliomyelitis, tetanus and diphtheria. A population-based cross-sectional study was conducted, covering the population aged 2-39 years. The sample was stratified by age and rural-urban environment, and informed consent obtained to take blood specimens from subjects attending phlebotomy centres. The study included 3,932 persons and the prevalence of antibodies against all three types of poliovirus exceeded 94% across all age groups. From a high of 96% in subjects under the age of 15 years, immunity against diphtheria steadily declined to a low of 32.3% in subjects aged 30-39 years. Similarly, tetanus antitoxin concentrations indicating basic protection were present in 98.9% of the under-14 years age group; thereafter, immunity declined, until reaching 54.6% in the 30-39 years age group.

Seroprevalence of HIV and HTLV in a representative sample of the Spanish population.

HIV and HTLV seroprevalence was determined by means of unlinked anonymous testing of 2144 sera, originally obtained from primary care patients by representative sampling of the Spanish population aged 15-39 years in 1996. HIV-1 seroprevalence was 4.3 per 1000 population in the 15-39 years age group [95% confidence interval (CI), 1.5-10.7] and 5.6 per 1000 (95% CI, 1.8-15.3) in the 20-39 years age group. Seroprevalence proved higher in males and urban residents. No antibodies to HIV-2 and HTLV-I were detected in any of the sera studied. However, presence of antibodies to HTLV-II was confirmed in one serum sample, while HTLV seroreactivity, though detected in another, could not be typed. The two HTLV-positive results equated to a seroprevalence of 1.9 per 1000 in the 20-39 years age group (95% CI, 0.3-8.6). HIV-I seroprevalence was consistent with previous estimates yielded by back-calculation. The level of HTLV seroprevalence found suggests endemicity.

Two outbreaks of mumps in children vaccinated with the Rubini strain in Spain indicate low vaccine efficacy.

This paper reports a descriptive study of two outbreaks of mumps in Spanish towns in 1998 and an assessment of the efficacy of the vaccine used. It provides evidence of the low level of protection against the mumps virus that has been observed previously

[Seroepidemiologic study of cytomegalovirus in childbearing age women in the community of Madrid]. / Estudio seroepidemiológico frente a citomegalovirus en mujeres en edad fértil de la Comunidad de Madrid.

BACKGROUND: The determination of seroprevalence against cytomegalovirus in women from the Autonomous Region of Madrid (Spain), and the study of risk factors associated with the infection. MATERIAL AND METHOD: Cytomegalovirus specific IgG was studied in serum samples from the women included in the 2nd Serosurvey of the Autonomous Region of Madrid. RESULTS: Seroprevalence was 75.6%, ranging from 60.6% (age group 15-24 yr) to 94.6% (36-45), being significantly higher in mothers and in those living in stacking conditions, and significantly lower in women with university studies. CONCLUSIONS: Cytomegalovirus infection is frequent in childbearing women from Madrid, more than 30% of them could be infected.

Trends in hepatitis A virus infection with reference to the process of urbanization in the greater Madrid area (Spain).

Hepatitis A is an infection transmitted by the fecal-oral route. Endemicity within a specific country is directly related to sanitation and hygienic standards, while being inversely related to socioeconomic conditions. We studied how the process of urbanization witnessed in Madrid had influenced the transmission of hepatitis A infection. In the Madrid Autonomous Region, this process first began in the early sixties and was not brought to a close until the late seventies. Catalytic models were used to estimate the annual infection rate, lambda, on the basis of seroprevalence data stratified by age. A cohort effect related to a fall-off in infancy-related hepatitis A virus (HAV) is to be observed in the results for the last few years. The model permits four birth cohort-based groups to be differentiated by lambda: individuals born pre-1960, lambda = 0.082 (95% CI 0.095-0.070); those born in the early sixties, lambda = 0.052 (95% CI 0.060-0.042); whose members were born in the late sixties, lambda = 0.033 (95% CI 0.041-0.025); and those born in the late seventies, lambda = 0.017 (95% CI 0.020-0.013). The first group includes those born before the urbanization process had started. The second and third groups coincide with the development stage of that process, hence exhibiting transitional rates. The fourth group reflects the process in its consolidation stage. This reduction in the transmission of infection has changed the manner of presentation, so that while isolated cases or small outbreaks tend to be more common nowadays, occasionally epidemics may evolve explosively. The average age at presentation has risen and the likelihood of symptomatic infection is higher.

Epidemiology of canine leishmaniasis in the Madrid region, Spain.

A cross-sectional serological survey was carried out in the Madrid Autonomous Region (Comunidad de Madrid) in order to study and describe canine leishmaniasis epidemiology. The presence of leishmaniasis-specific antibodies was ascertained by immunofluorescence testing, 591 dogs were screened, revealing a prevalence of 5.25% (95% confidence interval 7.4-3.6), with no difference being encountered between rural and periurban areas. Age-specific prevalence exhibits a peak at 2-3 years and another at 7-8 years. Incidence or force of infection by occupation is as follows: pet dogs 0.059 (95% confidence interval 0.009-0.108) and working dogs 0.035 (95% confidence interval 0.012-0.057), there being a ratio between infection rates of 1.7, viz., indicating a 70% greater risk of infection among pet than among working dogs. The basic case reproduction number R0 is 1.06, suggesting that very intense control measures would not be needed for a drop in prevalence and incidence of infection to be achieved.