[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

[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.

[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.

[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.

[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.

[Epidemic outbreak of parotiditis in a school population and efficacy of antiparotiditis vaccination]. / Epidemia de parotiditis en una población escolar y eficacia de la vacunación antiparotiditis.

We report an epidemic outbreak of parotiditis in Villafranca del Cid (Castellón) in 1987. The overall number of cases was 104, of which 96 were schoolchildren aged 9.4 +/- 8 years. The attack rates were 3.5% for the town population and 41.9% for schoolchildren at risk. Ninety-two patients had not received parotiditis vaccination. The effectiveness of parotiditis vaccine was 86.0% (95% confidence limits: 63.5%-94.6%) for schoolchildren. To erradicate parotiditis it is suggested that vaccination should be carried out in all children at risk, not previously vaccinated, at the beginning of the school term, and/or revaccination at ages 6-12 years with triple viral vaccine.