Atopic dermatitis incidence and risk factors in young adults in Castellon (Spain): A prospective cohort study.

INTRODUCTION: There are few atopic dermatitis (AD) incidence cohort studies in young adults, the etiology of this disease remains obscure, and AD risk factors in adults are not well understood. The objective of this study was to estimate AD ten-year incidence and prevalence in a cohort of adolescent aged 14-16 at inception in Castellon province in Valencia Region, Spain and describe related risk factors. MATERIAL AND METHODS: From 2002 to 2012, a population-based prospective cohort study was carried out. Questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were used with an additional questionnaire for related factors completed by participants and their parents, respectively, in 2002. In 2012 the same questionnaires were completed by the participants' through a telephone interview, and incidence and prevalence of AD were estimated. Directed acyclic graphs, Poisson regression and inverse probability weighted regression adjustment were used. RESULTS: The participation rate was 79.5% (1435/1805) with AD lifetime prevalence of 34.9% and AD incidence of 13.5 per 1000 person years. Females presented higher prevalence and incidence than males. After adjustment significant risk factors were being female, history of asthma or allergic rhinitis, family history of AD, history of respiratory infections, history of bronchitis, history of pneumonia, history of sinusitis, and birthplace outside Castellon province. The highest AD population attributable risks were female, 30.3%, and history of respiratory infections 15.3%. Differences with AD childhood risk factors were found. CONCLUSIONS: AD incidence in our cohort was high and several risks factors were related to AD.

Vitamin D status and latent tuberculosis infection: conversion in nursing homes, Spain.

OBJECTIVE: To examine the potential association between vitamin D (VitD) deficiency and latent tuberculosis infection (LTBI) and its effect on TB infection conversion (TBIC) incidence.MATERIAL AND METHODS: We carried out a cross-sectional and prospective cohort study of nine pulmonary TB cases that occurred in 2015-2016 in five nursing homes and one mental disability institution in Castellon, Spain. QuantiFERON®-TB Gold and the tuberculin skin test were used to detect LTBI and TBIC, respectively. Serum 25-hydroxyvitamin D was measured using chemiluminescence immunoassay. Poisson regression and inverse probability weighting were used for statistical analyses.RESULTS: The study included 448 residents, 341 staff members with 48 relatives of TB cases (participation rate 82%): of these, respectively 122 (27.2%), 37 (10.9%) and 7 (14.6%) were LTBI-positive; and respectively 22 (7.7%), 10 (3.8%) and 1 (3.7%) were TBIC-positive. LTBI was not associated with VitD status. Severe VitD deficiency (SVDD; defined as VitD level < 10 ng/ml), found in 45.1% of residents, as well as VitD levels of <30 ng/ml (aRR 10.41 95% CI 1.48-73.26), were associated with increased TBIC risk (adjusted relative risk [aRR] 12.1, 95% CI 1.51-97.10), suggesting SVDD as a threshold effect. CONCLUSION: Severe VitD deficiency is a TBIC risk factor.

Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study.

BACKGROUND: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. METHODS: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. RESULTS: The mean age of participants was 24.9±0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR)=2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR=4.05; 95% CI 1.7-9.6), bronchitis (RR=2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR=0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. CONCLUSIONS: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found.

Detection of foodborne Salmonella Typhimurium outbreaks / Detección de brotes de toxiinfecciones alimentarias por Salmonella Typhimurium

No disponible

Estimación de la incidencia de síndrome gripal durante la pandemia de gripe de 2009 / An estimate of the incidence of influenza-like illness during the influenza pandemic of 2009

Introducción: La pandemia de gripe de 2009 tuvo una gran repercusión social. Se dedicaron muchos recursos sanitarios a la atención médica, la prevención y la vigilancia epidemiológica. La vigilancia epidemiológica se sustenta en la notificación de casos de síndrome gripal y de casos confirmados de gripe. El objetivo fue la estimación de la incidencia real de síndrome gripal durante la pandemia de gripe de 2009. Métodos: Sistema de captura-recaptura durante el mes de mayor incidencia en Castellón. Se utilizaron 2 sistemas de información: a) sistema electrónico de notificación de enfermedades de declaración obligatoria (EDO), y b) datos de laboratorio (LAB). Las estimaciones se han realizado estratificando por grupo de edad y semana. Se calculó el coeficiente de independencia en estos estratos. Resultados: En total se identificaron 7.181 casos EDO y 524 LAB, de los que 211 coincidían en ambos sistemas. La estimación total fue de 17.785 casos en un mes. Ello significa que en el periodo estudiado casi el 4% de las personas del área sufrieron un cuadro gripal (incidencia acumulada), y aproximadamente una de cada 100 personas estuvo diariamente afectada (prevalencia diaria). Acudieron a consulta de atención primaria (EDO) un 40% de los afectados (sensibilidad del sistema EDO). Conclusiones: Para obtener una estimación de la incidencia real en la población durante la pandemia habría que multiplicar la cifra de consultas médicas por un factor de 2,5. Este factor es inferior al estimado en periodos sin alerta pandémica

Introduction: The influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009. Methods: The capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i) electronic reporting of Notifiable Diseases (ND), and (ii) laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata. Results: No dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care. Conclusions: To obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period,the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert

Vitamin D status and incidence of tuberculosis infection conversion in contacts of pulmonary tuberculosis patients: a prospective cohort study.

The objective of this study was to estimate the relationship between serum vitamin D (VitD) status and tuberculosis (TB) infection conversion (TBIC), measured by the tuberculin skin test (TST) and an interferon-gamma release assay, the QuantiFERON-TB Gold In-Tube (QFT-GIT) test, in the contacts of pulmonary TB patients in Castellon (Spain) in a prospective cohort study from 2010 to 2012. Initially, the participants were negative to latent TB infection after a screening that included TST and QFT-GIT tests, and other examinations. A baseline determination of 25-hydroxyvitamin D [25(OH)D] was obtained by chemiluminescence immunoassay. After 8-10 weeks, participants were screened for a second time to determine TB infection conversion (TBIC). Poisson regression models were used in the statistical analysis. Of the 247 participants in the cohort, 198 (80·2%) were screened twice and 18 (9·1%) were TBIC cases. The means of VitD concentration in the TBIC cases and the non-cases were 20·7±11·9 and 27·2±11·4 ng/ml (P = 0·028), respectively. Adjusted for high exposure and TB sputum acid-fast bacilli (AFB)-positive index case, higher serum VitD concentration was associated with low incidence of TBIC (P trend = 0·005), and an increase of 1 ng/ml VitD concentration decreased the incidence of TBIC by 6% (relative risk 0·94, 95% confidence interval 0·90-0·99, P = 0·015). The results suggest that sufficient VitD level could be a protective factor of TBIC.

An estimate of the incidence of influenza-like illness during the influenza pandemic of 2009.

INTRODUCTION: The influenza pandemic of 2009 had a great social impact. Many health resources were devoted to the care, prevention and surveillance of this disease. Epidemiological surveillance is based on the reporting of cases of influenza-like illness (ILI) and confirmed influenza cases. The objective was to estimate the true incidence of ILI during the influenza pandemic of 2009. METHODS: The capture-recapture method was applied during the month of highest influenza incidence in Castellón. Two notification systems were used: (i)electronic reporting of Notifiable Diseases (ND), and (ii)laboratory-based (LAB) data collection. Estimates were made by stratifying by age group and week. Independence coefficients were calculated for those strata. RESULTS: No dependence was found between stratification variables and the reporting system. A total of 7,181 ND cases and 524 LAB cases were identified, of which 211 were recorded in both systems. The estimated total of cases was 17,785 in a single month. In the study period, almost 4% of people in the area suffered flu symptoms (cumulative incidence), with 1% being affected each day (daily prevalence). The sensitivity of the ND system was 40%, i.e., the percentage of patients seeking primary care. CONCLUSIONS: To obtain an estimate of the actual incidence of influenza-like illness in the population during a pandemic period, the number of medical consultations should be multiplied by a factor of 2.5. This factor is lower than that estimated for periods without pandemic alert.

Rotavirus vaccination effectiveness: a case-case study in the EDICS project, Castellón (Spain).

In Spain, in 2006, two oral live-attenuated vaccines against rotavirus disease were licensed for infants up to 6 months. Recent data suggest that vaccine efficacy may vary by region. This makes the real-life postmarketing monitoring of rotavirus vaccination effectiveness an important aspect of rotavirus epidemiologic surveillance. We carried out a case-case study to assess the rotavirus vaccination effectiveness in children from 2 to 35 months of age during the year 2009 in Castellón. As a second- and counterfactual objective to evaluate the possible selection bias and the specificity of the association, we evaluated the "effectiveness" of pneumococcal vaccination against rotavirus diarrhea. Cases were 71 children with confirmed rotavirus gastroenteritis, and controls were 261 children with positive results to any other organism that was not rotavirus. The immunization status of each child, the number of doses and dates of vaccination were assessed by consulting the Regional Immunization Registry. The lowest proportion of vaccinated cases was observed among rotavirus diarrhea (2.8%). The proportion of vaccinated children among the control group was 21.8%. The effectiveness of vaccination with at least one dose of vaccine against rotavirus was 87.7% (45.5-99.7%). If we restrict the analysis to non-hospitalized children, this figure was slightly lower, 83.5% (25.4-96.3%). As expected, pneumococcal vaccination was not protective against rotavirus infection showing the specificity of the association found. The immunization information systems in combination with population-based studies of the incidence of infectious gastroenteritis, such as EDICS offer appropriate conditions for postmarketing monitoring of vaccine effectiveness.

Brote epidémico de dermatitis por la oruga procesionaria del pino (Thaumetopoea pityocampa) en escolares / Outbreak of dermatitis caused by pine processionary caterpillar (Thaumetopoea pityocampa) in schoolchildren

Fundamento: Describir un brote de dermatitis por exposición a las orugas procesionarias del pino (Thaumetopoea pityocampa) ocurrido el 15 de marzo del 2006 en escolares, que realizaron una estancia vacacional en una masía rural a 2 Km de Villahermosa del Río (Castellón). Métodos: Se realizó un estudio epidemiológico transversal que incluyó a los setenta escolares, de 10 años de edad, y a 3 profesores procedentes de Castellón. Se empleó un cuestionario específico para ser cumplimentado por los escolares. Resultados: Seis casos de dermatitis (tasa de ataque 8,6%: 6/70) ocurrieron después del baño en la piscina climatizada de la masía al secarse con toallas, que habían dejado fuera del recinto de la piscina, y la Thaumetopoea pityocampa se deslizó sobre ellas. Los casos precisaron atención médica con administración de antihistamínicos, corticoides y duchas de agua fría. El riesgo de sufrir el cuadro por contacto con la Thaumetopoea pityocampa fue muy alto (Odds Ratio = 157,2; Intervalo de confianza del 95% 18,4-∞). Se recogieron Thaumetopoea pityocampa en las inmediaciones de la piscina y se observaron sus nidos en pinos próximos. Conclusiones: La presencia de Thaumetopoea pityocampa en zonas próximas a albergues rurales puede ser causa de brotes epidémicos y se requiere educación sanitaria de los escolares y eliminación de los nidos de Thaumetopoea pityocampa en las inmediaciones de estos albergues (AU)

Background: To describe a dermatitis outbreak caused by exposure to pine processionary caterpillar (Thaumetopoea pityocampa) that took place on March 15th, 2006, in schoolchildren during their stay at a rural farm holiday centre in Villahermosa del Río (Castellón). Methods: A cross sectional epidemiological study was carried out on seventy schoolchildren, average age 10 years, and 3 teachers from Castellón. A specific questionnaire was used to be filled in by the schoolchildren. Results: Six cases of dermatitis (attack rate 8.6%: 6/70) took place after children had swum in the heated farm pool and dried themselves with towels that had been left outside the heated pool enclosure, where they had come into contact with Thaumetopoea pityocampa. The cases needed medical attention, with prescription of antihistamine drugs, corticosteroids, and cold showers. The risk of dermatitis from contact with Thaumetopoea pityocampa was very high (Odds Ratio=157.2 Confidence Interval 95% 18.4-∞). Thaumetopoea pityocampa were collected near the swimming pool and Thaumetopoea pityocampa nests were observed on nearby pines. Conclusions: The presence of Thaumetopoea pityocampa near rural centres can cause outbreaks. Health education for schoolchildren and the removal of Thaumetopoea pityocampa nests near these centres are required (AU)

[Outbreak of dermatitis caused by pine processionary caterpillar (Thaumetopoea pityocampa) in schoolchildren]. / Brote epidémico de dermatitis por la oruga procesionaria del pino (Thaumetopoea pityocampa) en escolares.

BACKGROUND: To describe a dermatitis outbreak caused by exposure to pine processionary caterpillar (Thaumetopoea pityocampa ) that took place on March 15th, 2006, in schoolchildren during their stay at a rural farm holiday centre in Villahermosa del Río (Castellón). METHODS: A cross sectional epidemiological study was carried out on seventy schoolchildren, average age 10 years, and 3 teachers from Castellón. A specific questionnaire was used to be filled in by the schoolchildren. RESULTS: Six cases of dermatitis (attack rate 8.6%: 6/70) took place after children had swum in the heated farm pool and dried themselves with towels that had been left outside the heated pool enclosure, where they had come into contact with Thaumetopoea pityocampa. The cases needed medical attention, with prescription of antihistamine drugs, corticosteroids, and cold showers. The risk of dermatitis from contact with Thaumetopoea pityocampa was very high (Odds Ratio=157.2 Confidence Interval 95% 18.4-inf). Thaumetopoea pityocampa were collected near the swimming pool and Thaumetopoea pityocampa nests were observed on nearby pines. CONCLUSIONS: The presence of Thaumetopoea pityocampa near rural centres can cause outbreaks. Health education for schoolchildren and the removal of Thaumetopoea pityocampa nests near these centres are required.

[Risk factors for the occurrence of sporadic Campylobacter, Salmonella and rotavirus diarrhea in preschool children]. / Factores de riesgo de los casos esporádicos de diarrea por Campylobacter, Salmonella y rotavirus en niños preescolares.

BACKGROUND: Sporadic cases of diarrhea in preschool children are highly frequent, especially those caused by rotavirus, Campylobacter and Salmonella. The aim of this study was to identify some of the factors associated with these processes. MATERIAL AND METHODS: A case-control study of hospitalized incident cases aged less than 3 years old was performed. Questionnaires were administered at admission, before the results of stool tests were known. Susceptibility, food exposure, and environmental factors were investigated. Infants aged less than 1 year were analyzed separately. RESULTS: A total of 117 patients (rotavirus in 31, Campylobacter in 228 and Salmonella in 21, negative results in 37) and 84 controls were studied. Several protective factors, such as breast feeding and prior antibiotic use, were identified. Risk factors for diarrhea were exposure to meat products (eating or environmental exposure in the kitchen), some kinds of pets, and attendance at day care. Differences were found by etiology and age. In the culture-negative group, no risk factors were identified. CONCLUSION: The problems posed by epidemiological study of this issue are discussed. The main findings in each group of cases are interpreted and proposals are made for their application in the control and prevention of these diseases.

Factores de riesgo de los casos esporádicos de diarrea por Campylobacter, Salmonella y rotavirus en niños preescolares / Risk factors for the occurrence of sporadic Campylobacter, Salmonella and rotavirus diarrhea in preschool children

Antecedentes: Los casos esporádicos de diarrea en niños pequeños son muy frecuentes, sobre todo por rotavirus, Campylobacter y Salmonella. Se pretende identificar los factores asociados con estos procesos. Material y métodos: Estudio de casos y controles. Casos de diarrea hospitalizados menores de 3 años. Entrevista realizada inmediatamente al ingreso, antes de conocer el resultado del coprocultivo. Se investigaron factores de susceptibilidad, de alimentación y ambientales. Se ha distinguido en niños mayores y menores de 1 año. Resultados: Un total de 117 pacientes (rotavirus, 31; Campylobacter, 28; Salmonella, 21; negativos, 37) y 84 controles. Se identificaron varios factores protectores como lactancia materna y toma previa de antibiótico. Factores de riesgo relacionados como la exposición a productos cárnicos (por ingesta o ambiental en la cocina), a algunos animales domésticos o asistencia a guarderías. Hubo diferencias por tipo de germen y por grupo de edad. En el grupo de pacientes con el coprocultivo negativo no se identificaron factores de riesgo. Conclusión: Se discuten las dificultades que plantea el estudio epidemiológico de este tipo de casos. Se interpretan los hallazgos por grupos de microorganismos, por grupo de edad, y se plantea su aplicación en el control y prevención de estos procesos

Background: Sporadic cases of diarrhea in preschool children are highly frequent, especially those caused by rotavirus, Campylobacter and Salmonella. The aim of this study was to identify some of the factors associated with these processes. Material and methods: A case-control study of hospitalized incident cases aged less than 3 years old was performed. Questionnaires were administered at admission, before the results of stool tests were known. Susceptibility, food exposure, and environmental factors were investigated. Infants aged less than 1 year were analyzed separately. Results: A total of 117 patients (rotavirus in 31, Campylobacter in 228 and Salmonella in 21, negative results in 37) and 84 controls were studied. Several protective factors, such as breast feeding and prior antibiotic use, were identified. Risk factors for diarrhea were exposure to meat products (eating or environmental exposure in the kitchen), some kinds of pets, and attendance at day care. Differences were found by etiology and age. In the culture-negative group, no risk factors were identified. Conclusion: The problems posed by epidemiological study of this issue are discussed. The main findings in each group of cases are interpreted and proposals are made for their application in the control and prevention of these diseases