Early intervention in pertussis outbreak with high attack rate in cohort of adolescents with complete acellular pertussis vaccination in Valencia, Spain, April to May 2015.

Forty-three pertussis cases reported in May 2015 in Valencia were linked to a school outbreak where 90% of the students had been vaccinated. Cases were diagnosed upon paediatrician consultation and in hospital emergency units. Approximately half of the cases were students born in 2002, the first age cohort with complete shift to acellular pertussis vaccine. Public health intervention, visiting school premises to conduct interviews, sample collection and early antibiotic prophylaxis stopped further spread in the community.

[Outbreak of shigellosis in a lower-class district]. / Brote de shigellosis en un barrio de nivel social bajo.

BACKGROUND: The outbreaks of Shigella sonnei in our environment frequently involve day care centers and elementary schools. An outbreak of shigellosis in a lower-class district is reported. The purpose of this study is that of pinpointing the center of infection, the means of contagion, the characteristics of those infected and of assessing the suitability of the measures taken. METHODS: For monitoring the outbreak over time, a combined observational timeline study was conducted within a territory the bounds of which were marked by means of the conventional epidemiological monitoring variables (time, place and individual). The infectivity of the center of infection (contagion rate) is analyzed by age, gender and school; rate ratio and percentage attributable thereto. RESULTS: On a time-related basis, the outbreak in question started on week 46/97 and ended on week 8/98. This outbreak involved 218 individuals (110 males and 108 females) totaling 5.46% of the district. The highest frequency was found among the 0-4 age group (43.6%), 29.4% in day care (70.32% contagion rate) with a relative risk of 3.9 (95% CI: 2.57-5.93) and 74.36% attributable percentage. The rate ratio between day care and the schools in the district in question is 5.62 (95% CI: 4.33-7.31). Stool cultures were taken and analyzed in 84 cases (38.5%), Shigella sonnei being detected in 38 cases (17.4%). Antibacterial treatment (amoxicillin-clavulan) was set out and individual and group health and safety measures were employed. CONCLUSIONS: The long communicability period and the small number of viable microorganisms necessary for causing this disease fostered its being passed on from one person to another at school and in the home. The measures employed effectively confined the contagion of the infectious agent at the schools.

[School failure in a cohort of adolescents]. / Fracaso escolar en una cohorte de adolescentes.

OBJECTIVE: To evaluate a cohort of adolescents as to whether their personal characteristics and/or determined habits of health and social relations bore any relation to the state of their studies two years later. DESIGN: A prospective study following a cohort of adolescents. PARTICIPANTS AND SETTING: Third-year ESO (aged c. 14) adolescents from the four state secondary schools in Puerto de Sagunto. INTERVENTIONS: Once the cohort (n = 551) was defined, in November 1995 the students themselves filled in a questionnaire on health and relationship habits. Two years afterwards they were located through school registers and classified as good if they were in the appropriate year, repeat if they were repeating a year and disappeared if they had left school. These last two categories were both considered school failures (SF). MEASUREMENTS AND RESULTS: 222 students were classed as SF (40%). 118 of these (21.4%) had left and 104 (18.9%) were repeating a year. There were statistically significant differences in the following characteristics measured at the start of the study: greater SF among boys than girls (46.4%/35.6%): the disappeared had a higher average age than the good students (14.98/14.17), higher average number of siblings (2.73/2.26), and higher average of nights they went out during the week (1.65/0.84). Mean family income was lower in the repeat group (1926087/2475436 pesetas); the money students received weekly was higher in both SF groups (over 900/641 pesetas). Students whose fathers have university degrees made up only 7.4% of SF; and no student whose mother had a university degree was SF. 17.5% of those who said they spent their free time with their family were SF, whereas 53% of those who devoted their free time basically to enjoying themselves were SF. On drug consumption, those who replied they never smoked had 27.2% SF, never consumed alcohol 25.8% SF, never took marihuana 35.3% SF, and never consumed other drugs 39.5% SF. Students who said their relationships with family and teachers was bad had 70% and 62.2% of SF, respectively. 70% of those who felt depressed were SF. CONCLUSIONS: This study confirms that a favourable family atmosphere is important in preventing school failure. It also makes clear that young people's social relationships and health habits are closely associated to their being a standard student or a school failure.

[The evolution of health and relationship habits of an adolescent cohort of Puerto de Sagunto (1995-1996)]. / Evolución de hábitos de salud y de relación de una cohorte de adolescentes de Puerto de Sagunto (1995-1996). Grupo de Trabajo TBC-3. Valencia.

OBJECTIVE: To know the prevalence of tobacco consumption, alcohol and marihuana as well as the habits of relationship, in an adolescents cohort of 3rd of Obligatory Secondary Teaching (ESO), that accede for the first time to one of the four secondary school of Puerto de Sagunto and the evolution of these habits after a year of follow-up. DESIGN: Transverse observational study with data withdrawal in two moments. Site. In the four secondary school of Puerto de Sagunto (Valencia). PATIENT AND OTHERS PARTICIPANTS: Adolescent of 3rd of ESO that accede for the first time to the four secondary school of Puerto de Sagunto in the course 95-96. INTERVENTIONS: A self-fully validated habits poll of health and of relationship was given to the pupils of 3rd of ESO (n = 573), and a year after was given the same poll, to the pupils already in 4th of ESO (n = 395). MEASUREMENTS AND RESULTS: On health habits, were found meaningful statistic differences in various variables: in tobacco consumption several times to the month passes of the 30% to the 40%, in alcohol consumption more than proven passes of the 35% to the 52%, in have you intoxicated the response never passes of the 67% to the 57%, in the paragraph of marihuana consumption, the response never passes of the 82% to the 72%. On the habits of relationship were found significant statistic differences with respect to number of nocturnal exists during the week that goes from 1.07 to 1.33, the return hour before 10 passes of the 23% to the 8%, as well as the type of associations to those which belong, sports club passes of the 38% to the 46%. In the paragraph of relationship to their teachers, the response good passes of the 89% to the 93%. CONCLUSIONS: The step of 14 to 15 years supposes in this population an increase in alcohol consumption, tobacco and marihuana, they go out more days at night and return later to house, are associated more in sports clubs and have better relationships to their teachers. The knowledge of these habits permits the intervention with preventive programs, that attempt to change attitudes toward these toxic habits and to promote the healthiest.

[The evolution of pulmonary tuberculosis in health area no 4 in Valencia during the period 1988-1993]. / Evolución de la tuberculosis pulmonar en el área de salud 4 de Valencia durante el peródo 1988-1993.

BACKGROUND: Morbidity from Pulmonary tuberculosis, detected by the system EDO in the Autonomous Community of Valencia, shows an increasing trend and differential behaviour in relation with age and constitutes, with no doubt, a Public Health problem involving a joint action of multiple clinical care and preventive units. METHODS: In our study, the cases of notified and confirmed pulmonary tuberculosis over the period 1988-1993 in the Health Area number 4 (Region Camp de Morvedre 167.744 inhabitants) are analyzed by estimating the evolution of incidence, the diagnosis time and place where this diagnosis was made in accordance with the conventional variables of ecological studies and excluding from our registry the cases of those patients with co-infection by virus VIH. RESULTS: The growing evolution of incidence, the mean rate for the period (49.95.10(5) h.), the rate differential per age-groups during the period and the concentration of cases in the young age-groups (15-39 years) constitute, together with the diagnosis time (75.6 days in Primary Health Care; 74.3 in Hospital), the most outstanding results. Nevertheless, the prolongation of the diagnosis time for order age-groups (140-168 days in people older than 54 years) and the absence of a previous known contact, suggest the presence of undetected cases of TBC and dissemination ways other than the interfamily ones. CONCLUSIONS: An improved notification and identification of cases from hospital sources involves the necessity of reducing the mean diagnosis time and the research on the ways of transmission other than the interfamily ones; this explains a limited part of the incidence.

[Gastroenteritis outbreak associated with water consumption, possibly caused by Norwalk or Norwalk-like virus]. / Brote de gastroenteritis asociado al consumo de agua, posiblemente producido por virus tipo Norwalk o semejantes.

BACKGROUND: It is described an acute gastroenteritis outbreak of probable hydric transmission in Ontinyent (Valencia). It was declared on the 31st of January, 1992 and affected 3541 people according to the declaration done by the sanitary services who attended the patients. The clinical situation was characterized by the presence of profuse and watery diarrhoea, nausea, vomiting, abdominal pain and fever or febricula. METHODS: A preliminary study of the cases has been done, the information being treated with the classical method of descriptive epidemiology and a later study of the transversal observation type by means of a telephone inquiry. RESULTS: The results show that this outbreak affected approximately to a 30% of the population, and show the relation between consumption of water from the municipal water system and the outbreak, as well as the existence of a control population not affected for receiving a different water supply. CONCLUSION: Once rejected the bacterial origin for the results of the copro-cultivation done the analysis of the clinical and epidemiological characteristics of the outbreak, show a total agreement with the criteria described by Kaplan to characterize acute gastroenteritis outbreaks because of Norwalk-like virus.

[Study of temporary disability leave in the City of Játiva]. / Estudio de la incapacidad laboral transitoria en la ciudad de Játiva.

BACKGROUND: The study that we present is basically descriptive and contribute to try to characterize the morbidity of the insured working population of the city of Játiva. METHODS: The period studied is the year 1988. 2044 registers were analyzed for cause, sex and duration. The cases were classified according the CIE-9a. The results are expressed by proportions. The significant differences are valued by the Chi-square. The half duration of the process and his interval of confidence are studied. RESULTS: The respiratory diseases, with the 32.68%, the traumatisms and poisonings, with the 13.36% and the osteomuscular diseases with the 11.74% represent the first three causes of ILT. We found differences significant in the groups VI (Nervous system diseases) and XVII (Traumatisms and poisonings), more frequent for the men, and in the groups V (Mental disorders) and VIII (Respiratory diseases) more frequent for the women. CONCLUSIONS: The results obtained from the ILT study are important for the knowledge of the of the health situation in the city of Játiva.