[Epidemiology of leptospirosis in the wetlands of Southern Spain]. / Epidemiología de la leptospirosis en los humedales del sur de España.

OBJECTIVE: To find out whether the leptospirosis incidence rate among red swamp crayfish collectors in the harvesting season is higher than in the general population, and to identify risk factors and assess the direct and indirect health costs associated with leptospirosis seroconversion. METHOD: This study was carried out between 1 July 2017 and 31 March 2018 in the municipality of Isla Mayor (Seville, Spain). It took the form of a prospective cohort study (exposed population: swamp crayfish collectors; non-exposed population: general population). The population was invited to take part in a prevalence study to be conducted using the ELISA qualitative technique, and informed consent was obtained from those who agreed. Negative serology cases were then included in the cohort study. Both cohorts were monitored clinically and symptomatic cases were serology tested. A second serum sample was taken from the swamp crayfish collectors at the end of the monitoring period to detect asymptomatic cases. Serovars were confirmed by microscopic agglutination testing. A bivariate descriptive analysis was carried out and cumulative incidence and relative risk were calculated, with positive serology being taken as the dependent variable. RESULTS: A total of 278 people were included in the study, of whom 92 made up the swamp crayfish collectors cohort and 186 the general population cohort. Women made up 46.8% of the sample, but only 29.3% of the collectors cohort. The mean age was 45.1 (±16.4) years. Nine cases of seroconversion were detected: eight among swamp crayfish collectors and one in the general population. Overall cumulative incidence was therefore 3.2%: 8.7% in the exposed group and 0.5% in the non-exposed group. Relative risk was 16.2% (95% confidence interval: 2.1-127.4). The total cost of medical assistance and illness-related losses associated with leptospirosis was 1568€/case. CONCLUSIONS: Leptospirosis in Isla Mayor is strongly associated with red swamp crayfish collecting. It's incidence here is much higher than that reported in studies published in other countries.

Epidemiología de la leptospirosis en los humedales del sur de España / Epidemiology of leptospirosis in the wetlands of Southern Spain

Objetivo: Conocer si la incidencia de leptospirosis en los capturadores de cangrejo rojo durante el periodo de captura es superior a la de la población general, así como identificar factores de riesgo y estimar los costes sanitarios directos e indirectos asociados a los casos de seroconversión de dicha enfermedad.Método: Este estudio se realizó desde el 1 de julio de 2017 hasta el 31 de marzo de 2018. Se llevó a cabo un estudio de cohortes prospectivo (población expuesta: capturadores de cangrejo rojo; población no expuesta: población general) en el municipio de Isla Mayor (Sevilla, España). Previo consentimiento informado, se invitó a la población al estudio de prevalencia mediante la técnica cualitativa ELISA. Los que tuvieron serología negativa fueron incluidos en el estudio de cohortes. Ambas cohortes se siguieron clínicamente y a los casos sintomáticos se les realizó serología. A los capturadores de cangrejo rojo se les tomó una segunda muestra de suero al final del seguimiento para detectar asintomáticos. La serovariedad se confirmó mediante aglutinación microscópica. Se realizó un análisis descriptivo bivariado y se calcularon la incidencia acumulada y el riesgo relativo. La serología positiva se tomó como variable dependiente.Resultados:Se incluyeron en el estudio 278 personas, de las que 92 constituían la cohorte de capturadores y 186 la de población general. El 46,8% de la muestra eran mujeres, aunque entre los capturadores de cangrejo rojo estas solo representaban el 29,3%. La edad media de la muestra fue de 45,1 (± 16,4) años. Se detectaron nueve seroconversiones: ocho en capturadores de cangrejo rojo y una en población general. Por lo tanto, la incidencia acumulada fue de 8,7% en capturadores de cangrejo rojo y de 0,5% en población general, siendo el riesgo relativo de 16,2 (intervalo de confianza del 95%: 2,1-127,4). El coste total de la asistencia sanitaria y de las pérdidas por enfermedad asociadas a la leptospirosis fue de 1568 € por caso(AU)

Objective: To find out whether the leptospirosis incidence rate among red swamp crayfish collectors in the harvesting season is higher than in the general population, and to identify risk factors and assess the direct and indirect health costs associated with leptospirosis seroconversion. Method: This study was carried out between 1 July 2017 and 31 March 2018 in the municipality of Isla Mayor (Seville, Spain). It took the form of a prospective cohort study (exposed population: swamp crayfish collectors; non-exposed population: general population). The population was invited to take part in a prevalence study to be conducted using the ELISA qualitative technique, and informed consent was obtained from those who agreed. Negative serology cases were then included in the cohort study. Both cohorts were monitored clinically and symptomatic cases were serology tested. A second serum sample was taken from the swamp crayfish collectors at the end of the monitoring period to detect asymptomatic cases. Serovars were confirmed by microscopic agglutination testing. A bivariate descriptive analysis was carried out and cumulative incidence and relative risk were calculated, with positive serology being taken as the dependent variable. Results: A total of 278 people were included in the study, of whom 92 made up the swamp crayfish collectors cohort and 186 the general population cohort. Women made up 46.8% of the sample, but only 29.3% of the collectors cohort. The mean age was 45.1 (±16.4) years. Nine cases of seroconversion were detected: eight among swamp crayfish collectors and one in the general population. Overall cumulative incidence was therefore 3.2%: 8.7% in the exposed group and 0.5% in the non-exposed group. Relative risk was 16.2% (95% confidence interval: 2.1-127.4). The total cost of medical assistance and illness-related losses associated with leptospirosis was 1568€/case. (AU)

[Measles outbreak in a socially deprived area of the province of Seville, Spain]. / Análisis de un brote de sarampión en una barriada de la provincia de Sevilla, España.

BACKGROUND: In 2011 in Seville (Spain), measles outbreak affected 1759 people. It began in the neighbourhood of Santa Isabel (city San Juan de Aznalfarache), where Roma community resides. We described the outbreak epidemiologically and calculated the risk of disease in the population. METHOD: Descriptive study of outbreak and cohort study. Exposed population was considered to Barriada resident and not exposed to the rest of the municipality. The data sources were: the Institute of Statistics of Andalusia, the social services of San Juan´s town and the Epidemiological Surveillance System of Andalusia. We described the outbreak and incidences were calculated and Relative Risk. The cases were confirmed by clinical, laboratory and/or epidemiological. RESULTS: In the neighbourhood the cases were concentrated among the group between 2 and 19 years, while in the rest of the town occurred in children under 2 and over 19 years. The overall incidence of the outbreak was 0,98 per 1.000 inhabitants, 4,94 in San Juan; from 23,15 in the exposed, 2,1 in the unexposed and in the group of 2-19 years 89,58 in the neighbourhood and 5,33 in the rest on the town. CONCLUSIONS: The outbreak affected more children under 20 years old, unvaccinated and residents in the neighborhood Santa Isabel. The risk of falling ill with measles in the neighbourhood was 11 and 17 in the group between 2 and 19 years. We need to develop strategies to reduce health inequalities that accompany some outbreaks.

Análisis de un brote de sarampión en una barriada de la provincia de Sevilla, España / Measles outbreak in a socially deprived area of the province of Seville, Spain

Fundamentos: En 2011 en Sevilla (España) un brote de Sarampión afectó a 1.759 personas. Comenzó en la Barriada de Santa Isabel, San Juan de Aznalfarache (Sevilla), donde reside una comunidad Romaní. El objetivo del trabajo es describir epidemiologicamente el brote en la localidad y calcular el riesgo de enfermar por sarampión de los residentes en la barriada Santa Isabel. Método: Se diseñó un estudio de cohortes retrospectivo. Se consideró población expuesta a los residentes en la barriada de Santa Isabel y no expuesta a la del resto del municipio. Las fuentes de datos fueron: el Instituto de Estadística de Andalucía, el Ayuntamiento del municipio y el Sistema de Vigilancia Epidemiológica de Andalucía. Se describió el brote y se calcularon incidencias y el Riesgo Relativo. Los casos fueron confirmados por criterios clínicos, de laboratorio y/o epidemiológicos. Resultados: En la barriada los casos se concentraron entre el colectivo etario de entre 2 y 19 años, mientras que en el resto de la localidad se produjo en menores de 2 y mayores de 19 años. La incidencia global del brote fue de 0,98 por 1.000 habitantes. En San Juan de 4,94 . Entre los expuestos fue de 23,15 y de 2,1 en los no expuestos. En el colectivo de 2 a 19 años la incidencia fue 89,58 por 1.000 habitantes en la Barriada y de 5,33 por 1.000 habitantes en el resto de la localidad. Conclusiones: El brote afectó en mayor medida a menores de 20 años, a población no vacunada y residente en la Barriada Santa Isabel. El riesgo de enfermar de Sarampión en la Barriada fue de 11 y de 17 en el colectivo entre 2 y 19 años. Precisamos elaborar estrategias que reduzcan las desigualdades en salud que acompañan a algunos brotes epidémicos(AU)

Background: In 2011 in Seville (Spain), measles outbreak affected 1759 people. It began in the neighbourhood of Santa Isabel (city San Juan deAznalfarache), where Roma community resides. We described the outbreak epidemiologically and calculated the risk of disease in the population. Method: Descriptive study of outbreak and cohort study. Exposed population was considered to Barriada resident and not exposed to the rest of the municipality. The data sourceswere: the Institute of Statistics ofAndalusia, the social services of San Juan’s town and the Epidemiological Surveillance System ofAndalusia.We described the outbreak and incidences were calculated and Relative Risk. The cases were confirmed by clinical, laboratory and /or epidemiological. Results: In the neighbourhood the cases were concentrated among the group between 2 and 19 years, while in the rest of the town occurred in children under 2 and over 19 years. The overall incidence of the outbreak was 0,98 per 1.000 inhabitants, 4,94 in San Juan; from 23,15 in the exposed, 2,1 in the unexposed and in the group of 2-19 years 89,58 in the neighbourhood and 5,33 in the rest on the town. Conclusions: The outbreak affected more children under 20 years old, unvaccinated and residents in the neighborhood Santa Isabel. The risk of falling ill with measles in the neighbourhood was 11 and 17 in the group between 2 and 19 years.We need to develop strategies to reduce health inequalities that accompany some outbreaks(AU)

[Measles outbreak in Campo de Gibraltar, Cádiz, Spain, during the Period February-July 2008]. / Brote de sarampión en Campo de Gibraltar, Cádiz, durante el período febrero-julio 2008.

BACKGROUND: On the 4th of February 2008, 2 cases of measles, epidemiologically linked (2 members of the crew of the Fast-Ferry Jaime I from the company Balearia, which performs the route Algeciras-Tangier), were notified to the Epidemiological Surveillance Network in Andalusia (SVEA). The aim of this paper is to epidemiologically characterize this population level outbreak detected in the area of Campo de Gibraltar, the vaccine effectiveness and the control measures implemented. METHODS: Descriptive observational study of reported cases. We have analysed the following variables: age, sex, municipality of residence, onset date, virus genotype, groups involved, previous immunization status, interventions, vaccine effectiveness. Information sources are SVEA records, vaccination program and individual digital story (Diraya). Rates 10(5) were calculated according to age group and frequency measurements. To compare vaccine effectiveness, the Chi(2) test was used. RESULTS: We confirmed 155 cases of measles, 88.4% by laboratory techniques. Most affected age groups under 2 years (19%) and from 21 to 40 (51%). The 54.2% male. The 72,14% were not vaccinated. Virus was isolated from imported measles genotype D4. The vaccine efficacy was greater than 99%. CONCLUSIONS: The outbreak of the imported measles virus was confirmed. More than half of the cases were not vaccinated. The decrease in the incidence in vaccinated individuals recommends the necessity of carrying out Catch-Up campaigns to increase the coverage therefore avoiding the appearance of these outbreaks.

Brote de sarampión en Campo de Gibraltar, Cádiz, durante el período febrero- julio 2008 / Measles outbreak in Campo de Gibraltar, Cadiz, Spain, during the period February-July 2008

Fundamento: El 4 de febrero de 2008 se notificó a la Red de VigilanciaEpidemiológica de Andalucía (SVEA), 2 casos de sarampiónvinculados epidemiológicamente, 2 tripulantes del Fast-Ferry Jaime Ide la Compañía Balearia, que realiza la línea de Algeciras - Tánger. Elobjetivo de este trabajo es caracterizar epidemiológicamente el brote deámbito poblacional detectado en la Comarca Campo de Gibraltar, lasmedidas de control implementadas y la efectividad vacunal.Método: Estudio observacional descriptivo de casos notificados.Se analizan las variables edad, sexo, municipio de residencia,sintomatología, fecha de inicio, colectivos implicados, estado vacunalprevio, intervenciones realizadas, genotipo del virus, y efectividadvacunal. Fuentes de información los registros del SVEA, programade vacunas e historia digital individual (Diraya). Se calcularontasas x 105 por grupo de edad y medidas de frecuencia. Para comparaciónde efectividad vacunal se utilizó test Chi2.Resultados: Se confirmaron 155 casos de sarampión, 88.4%por laboratorio. Grupos de edad mas afectados menores de 2 años(19%) y de 21 a 40 (51%). El 54.2% varones. El 72,14% no estabanvacunados. Se aisló virus sarampión Genotipo D4 importado. Laefectividad vacunal era superior al 99%.Conclusiones: Se confirma un brote por virus del sarampiónimportado. Mas de la mitad de los casos no estaban vacunados. Ladisminución de la incidencia en vacunados hace necesario recomendarcampañas de Cacht - Up que aumenten las coberturas para evitarla aparición de estos brotes vacunales(AU)

Background: On the 4th of February 2008, 2 cases of measles,epidemiologically linked (2 members of the crew of the Fast-FerryJaime I from the company Balearia, which performs the route Algeciras- Tangier), were notified to the Epidemiological SurveillanceNetwork in Andalusia (SVEA). The aim of this paper is to epidemiologicallycharacterize this population level outbreak detected inthe area of Campo de Gibraltar, the vaccine effectiveness and thecontrol measures implemented.Methods: Descriptive observational study of reported cases.We have analysed the following variables: age, sex, municipality ofresidence, onset date, virus genotype, groups involved, previousimmunization status, interventions, vaccine effectiveness. Informationsources are SVEA records, vaccination program and individualdigital story (Diraya). Rates 105 were calculated according to agegroup and frequency measurements. To compare vaccine effectiveness,the Chi2 test was used.Results: We confirmed 155 cases of measles, 88.4% by laboratorytechniques. Most affected age groups under 2 years (19%) andfrom 21 to 40 (51%). The 54.2% male. The 72,14% were not vaccinated.Virus was isolated from imported measles genotype D4. Thevaccine efficacy was greater than 99%.Conclusions: The outbreak of the imported measles virus wasconfirmed. More than half of the cases were not vaccinated. Thedecrease in the incidence in vaccinated individuals recommends thenecessity of carrying out Catch-Up campaigns to increase the coveragetherefore avoiding the appearance of these outbreaks(AU)