Erratum to: Changes in the pneumococcal disease-related hospitalisations in Spain after the replacement of 7-valent by 13-valent conjugate vaccine.

The original version of this article was published online with an incorrectly arranged Table 2. Also, Figs. 1 and 2 were missing the legends.

Changes in the pneumococcal disease-related hospitalisations in Spain after the replacement of 7-valent by 13-valent conjugate vaccine.

In Spain, anti-pneumococcal vaccination is recommended for all children under 2 years old, high-risk groups and adults ≥65 years old. However, it is not funded in most autonomous communities. This study aims to compare pneumococcal disease hospitalisation rates between Period 1 (2007-2009), when 7-valent (PCV7) vaccine was available, and Period 2 (2011-2013), after the change to 13-valent (PCV13) vaccine in Spain. Data on hospitalisations were obtained from the National Registry of Hospitalisations. We calculated hospitalisation rates (HRs) and hospitalisation rate ratios (HRRs) among periods by age group and autonomous community, for all and by clinical presentation. From 138,361 patients hospitalised, 83,528 (60.4 %) were males. The median age was 73.8 years. The most common clinical presentation was pneumonia (133,204 hospitalisations; 96.3 %), followed by septicaemia (7053 hospitalisations; 5.1 %) and meningitis (3182 hospitalisations; 2.3 %). In Period 2, hospitalisations among children <5 years old decreased for pneumonia [HRR: 0.37; 95 % confidence interval (95 % CI): 0.35 to 0.39] and meningitis (HRR: 0.53; 95 % CI: 0.44 to 0.65). For adults ≥65 years old, pneumonia (HRR: 0.49; 95 % CI: 0.49 to 0.50) and peritonitis (HRR: 0.34; 95 % CI: 0.19 to 0.63) hospitalisations decreased and septicaemia hospitalisations (HRR: 1.27; 95 % CI: 1.18 to 1.36) increased. Significant changes in HRs for pneumococcal disease were observed even without an integrated and continuous vaccination programme after the introduction of PCV13, especially in children <5 years old and for pneumonia. The impact of the PCV13 adult vaccination new recommendations on the septicaemia increase reported should be evaluated in the future.

Increase of pertussis incidence in 2010 to 2012 after 12 years of low circulation in Spain.

In Spain, whole cell pertussis vaccination started in 1975, with three doses before the age of 6-7 months. Doses at 15-18 months and 4-6 years were introduced in 1996 and 2001, respectively. Spain switched to an acellular vaccine in 2005. From 1998 to 2009, pertussis incidence rates remained ≤1.5 cases/100,000 inhabitants but increased from 2010 to 7.5 cases/100,000 in 2012. Data from 1998 to 2012 were analysed to assess disease trends and susceptible populations. We defined four epidemic periods: 1998-2001 (reference), 2002-05, 2006-09 and 2010-12. In 2002-05, the incidence rate increased in individuals aged 15-49 years (IRR: 1.41 (95% CI: 1.11-1.78)) and ≥50 years (IRR: 2.78 (95% CI: 1.78-4.33)) and in 2006-09 increased also in infants aged <3 months (IRR: 1.83 (95% CI: 1.60-2.09)). In 2010-12, the incidence rate increased notably in all age groups, with IRRs ranging between 2.5 (95% CI: 2.3-2.8) in 5-9 year-olds and 36.0 (95% CI: 19.4-66.8) in 20-29 year-olds. These results, consistent with the country's vaccination history, suggest a progressive accumulation of susceptible individuals due to waning immunity after years of low incidence. Further vaccination strategies should be assessed and implemented to prevent pertussis in pre-vaccinated infants, in whom the disease is more severe.

Circulation of mumps virus genotypes in Spain from 1996 to 2007.

Although the WHO recommends the use of genotyping as a tool for epidemiological surveillance for mumps, limited data on mumps virus (MV) genotype circulation that may be used to trace the patterns of virus spread are available. We describe the first complete series of data from Spain. The small hydrophobic region was sequenced from 237 MV-positive samples from several regions of Spain collected between 1996 and 2007. Six different genotypes were identified: A, C, D (D1), G (G1, G2), H (H1, H2), and J. Genotype H1 was predominant during the epidemic that occurred from 1999 to 2003 but was replaced by genotype G1 as the dominant genotype in the epidemic that occurred from 2005 to 2007. The same genotype G1 strain caused concomitant outbreaks in different parts of the world (the United States, Canada, and the United Kingdom). The remaining genotypes (genotypes A, C, D, and J) appeared in sporadic cases or small limited outbreaks. This pattern of circulation seems to reflect continuous viral circulation at the national level, despite the high rates of vaccine coverage.

[Update on chickenpox]. / Actualización en varicela.

Primary infection by varicella-zoster virus causes chickenpox and herpes zoster. At 14 years of age, 91% of the population have already suffered the illness and after 30 years, more than 95% have done so. In 1999, the hospitalization rate was 2.4 per 1,000 chickenpox cases in those under 14 and 15.5 per 1,000 cases in those over 14. A total of 73% of deaths recorded during the period 1991-2000 were in the older than 14 year old group. Efficacy of varicella vaccine after a 7-8 years period is 87%; a milder case of chickenpox (breakthrough) can appear in vaccinated people 42 days after vaccination. The introduction of the vaccine may be proposed to stop or decrease virus circulation among the population or to decrease complications and mortality from chickenpox. According to the objective proposed, different strategies that imply risks and benefits should be conducted.

Actualización en varicela / Update on chickenpox

La infección primaria por el virus varicella-zoster produce la varicela y el herpes zoster. A los14 años el 91% y a partir de los 30 años más del 95% de la población ya ha padecido la enfermedad. En el año 1999 la tasa de hospitalización en menores de 14 años fue de 2,6 por 1.000 casos de varicela y de 15,5 por 1.000 en los mayores de 14 años. El 73% de las muertes registradas durante el período 1991-2000 se han producido en mayores de 14 años. La eficacia de la vacuna antivaricela tras un período de 7-8 años es del 87%, en vacunados puede aparecer una varicela más leve, breakthrough, a los 42 días de la vacunación. La introducción de la vacuna puede plantearse para interrumpir o disminuir la circulación del virus en la población o para disminuir las complicaciones y la mortalidad. Según el objetivo planteado se deberían seguir distintas estrategias que implicaran beneficios y riesgos

Primary infection by varicella-zoster virus causes chickenpox and herpes zoster. At 14 years of age, 91% of the population have already suffered the illness and after 30 years, more than 95% have done so. In 1999, the hospitalization rate was 2.4 per 1,000 chickenpox cases in those under 14 and 15.5 per 1,000 cases in those over 14. A total of 73% of deaths recorded during the period 1991-2000 were in the older than 14 year old group. Efficacy of varicella vaccine after a 7-8 years period is 87%; a milder case of chickenpox (breakthrough) can appear in vaccinated people 42 days after vaccination. The introduction of the vaccine may be proposed to stop or decrease virus circulation among the population or to decrease complications and mortality from chickenpox. According to the objective proposed, different strategies that imply risks and benefits should be conducted

Waterborne outbreak among Spanish tourists in a holiday resort in the Dominican Republic, August 2002.

On 3 September 2002, the Spanish national centre of epidemiology (Centro Nacional de Epidemiologia--CNE) was alerted to a high number of gastroenteritis cases in Spanish tourists who had travelled to a hotel in Punta Cana on different days during august 2002. Entamoeba hystolitica cysts have been visualised by microscopy in the stools of several patients that sought medical attention in the Dominican Republic. The CNE informed the health authorities in the Dominican Republic and conducted in conjunction an epidemiological investigation. A descriptive study of the 76 initial cases estimated a mean illness duration of 5.1+2.9 days and a exposure period of 3.6+2.2 days. Following a retrospective cohort study, the attack rate was found to be 32.4%. Consequently, 216 (95% CI=114.75-317.25) spanish tourists had probably developed the illness. Stool samples were collected in Spain from untreated patients who still felt unwell. None of the samples were positive for E.hystolitica. On 10 September, a hygiene inspection was undertaken at the hotel. Samples of the ice and meals served at the buffet that day, yielded coliform bacteria. Consumption of water from the resort water system was the only risk factor associated with the symptoms (RR= 3.55; 95% CI =1.13-10.99). To avoid similar outbreaks occurring again at the hotel, it is essential to regularly monitor the water quality and to improve food handling hygiene standards. Basic food hygiene training for food handlers should be mandatory. An international guideline for the management foodborne and waterborne outbreaks among tourists in holiday resorts should be drawn up, involving all competent authorities of both destination and tourist origin countries.

Impact of human immunodeficiency virus infection on mortality among young men and women in Spain.

BACKGROUND: This paper describes the impact of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) mortality among young adults in Spain with specific reference to other causes of death. METHODS: Based on death registration data for the period 1980-1993, HIV/AIDS was compared against all other causes of death by gender, using specific rates in the 25-44 age group and standardized rates for potential years of life lost (PYLL). RESULTS: In 1993, HIV/AIDS was the leading cause of death among men aged 25-44 years (21.8% of all deaths) and the second leading cause of death among women (14.9%), exceeded only by cancer. Since 1982, the trend in the overall standardized mortality rate for men in the 25-44 age group has been reversed, showing a progressive increase. Similarly, since 1984 there has been a halt in the decline in female mortality. For both sexes, maintenance of these trends in mortality was largely ascribable to the effect of HIV/AIDS deaths which registered a marked rise, a rise far sharper than that witnessed for variations in all other causes studied. In 1993, the adjusted PYLL rate for HIV/AIDS for ages 1-70 rose to 615 per 100,000 population in men and 156 in women. These values accounted for 9.2% and 5.8% of PYLL for all causes, thereby ranking HIV/AIDS behind motor vehicle accidents as the second leading cause of premature death in men, and behind motor vehicle accidents and breast cancer as the third leading cause in women. For both sexes, the rise in the PYLL rate for HIV/AIDS from 1992 to 1993 proved far greater than that for all other causes of death. CONCLUSION: In Spain, HIV/AIDS has become the leading cause of death among young adults and is counteracting improvements in mortality due to other causes. It should therefore be regarded as a priority public health problem.

Childhood and adolescent cancer in Spain: mortality time trends 1956-1990.

Using log-linear Poisson modelling, trends in childhood cancer mortality among the population under 20 years of age in Spain are described over the 35-year period from 1956 to 1990. Overall cancer mortality and seven specific sites were considered: all leukaemias, Hodgkin's disease, non-Hodgkin's lymphomas, malignant brain tumours, kidney cancer, malignant bone neoplasms, and a broad category of ill-defined tumours. An age-period-cohort model was used to analyse the influence of age, period of death and birth cohort. Recent trends were estimated by restricting analysis to the last three 5-year periods. In general, mortality began to decline at the beginning of the 1970s, with reductions of 36% in males and 45% in females being registered between 1966-1970 and 1986-1990. The use of age-period-cohort models revealed an initially rising period effect attributable to diagnostic advances. The decline in mortality in post-1965 generations and the final downturn in the period effect are both most certainly a consequence of the remarkable progress achieved in the treatment of such tumours. During the final 15 years, there was a relative decline in mortality of approximately 20% every 5 years. However, in the case of malignant renal tumours in males and malignant bone tumours and non-Hodgkin's lymphomas in both sexes the situation remained stable.