Acute gastroenteritis outbreaks in closed and semi-closed facilities during 2017 in Catalonia, Spain.

Acute gastroenteritis (AGE) is a leading cause of disease worldwide. The aim of this prospective observational study is to describe the epidemiology of AGE in closed and semi-closed institutions in Catalonia. In 2017, 151 outbreaks were reported; 30.5% occurred in closed and semi-closed institutions; 71.7% caused by norovirus (NoV) (1532) cases. Person-to-person transmission accounted for 75.8% of NoV outbreaks vs 46.1% in non-NoV outbreaks (p < 0.001). Attack rate for NoV outbreaks was 33.1% vs 14.3% for non-NoV outbreaks (RR = 2.3; 95%CI: 2.0-2.7). The high number of affected underscores prompt and intense preventive measures to avoid the extension and perpetuation of outbreaks in these settings.

Viral etiology of mumps-like illnesses in suspected mumps cases reported in Catalonia, Spain.

We investigated the etiology of reported sporadic suspected mumps cases with a negative RT-PCR result for the mumps virus in the Barcelona-South region in 2007-2011. Samples from mumps virus-negative patients presenting unilateral or bilateral parotitis or other salivary gland swelling were tested for Epstein-Barr virus (EBV) by real-time PCR and for respiratory viruses by two multiplex-PCR-based assays to detect parainfluenza virus (PIV) 1-4, influenza virus (InV) A, B and C, respiratory syncytial virus (RSV), enterovirus, coronavirus 229E, coronavirus OC43, and rhinovirus. 101 samples were analyzed in persons aged 8 months to 50 years. Oral samples were collected on the first day of glandular swelling in 53 patients (52.5%), and on the first two days in 74 patients (73.3%). Viruses were detected in 52 (51.5%) of samples: one virus (25 EBV, 8 PIV3, 4 adenovirus, 4 PIV2, 1 PIV1, 1 InVA, and 1 enterovirus) was detected in 44 patients (84.6%), two viruses in 7 patients, and three viruses in one patient. In 58 patients (57.5%) whose sample was collected in the first 2 days after onset of parotitis and had received two doses of MMR vaccine and in 15 patients (14.8%) whose sample was collected on the first day, it is very likely that the cause was not the mumps virus. This would mean that 72.3% (73/101) of the reported sporadic suspected mumps cases were not mumps cases. The timing of oral-sample collection is crucial to correctly interpret the negative results for mumps virus RNA, especially when suspected cases occur in vaccinated persons.

MMR vaccine effectiveness in an outbreak that involved day-care and primary schools.

OBJECTIVE: In 2006, a large measles outbreak occurred in Catalonia (Spain), where the immunization schedule included two doses of MMR vaccine at 15 months and 4 years. The aim of this study was to investigate the vaccine effectiveness (VE) of MMR in children attending day-care and pre-school centres and to estimate the number of cases that would have been avoided by administering the first dose of MMR at 12 months. METHODS: A retrospective cohort study was carried out between October 2006 and January 2007 in day-care and pre-school centres with confirmed measles cases. VE was calculated in children aged ≥15 months without previous measles infection. Cases avoided by advancing the first dose of MMR to 12 months were estimated by calculating the basic and effective reproduction number in centres where transmission outside the class was observed. RESULTS: Fifteen centres and 1394 children were included. There were 77 confirmed cases (attack rate=5.5%). Vaccination coverage of the 1121 children aged ≥15 months was 91.6% and VE was 96% (95%CI 89-98%). There were 33 (41%) cases in the 81 children aged 12-14 months. Advancing the first dose to 12 months would have prevented 74 cases (91.5%) and lowered the attack rate from 41% to 8.6%. CONCLUSIONS: Over 90% of cases in children aged 12-14 months would have been avoided by MMR administration at 12 rather than 15 months. We strongly recommend advancing the first dose of MMR to 12 months in order to reduce the risk of measles outbreaks.

Effectiveness of measles vaccination for control of exposed children.

The effectiveness of measles vaccine for postexposure prophylaxis at educational centers was investigated. A total of 166 children who shared the classroom with 10 confirmed cases during the infectious period of cases were studied. Of total susceptible exposed children, 72% (54/75) were vaccinated and 25 contracted measles. Vaccine effectiveness in children vaccinated within 72 hours of exposure was 90.5% (95% confidence interval, 34%-99%).

Foodborne norovirus outbreak: the role of an asymptomatic food handler.

BACKGROUND: In July 2005 an outbreak of acute gastroenteritis occurred on a residential summer camp in the province of Barcelona (northeast of Spain). Forty-four people were affected among residents and employees. All of them had in common a meal at lunch time on 13 July (paella, round of beef and fruit). The aim of this study was to investigate a foodborne norovirus outbreak that occurred in the residential summer camp and in which the implication of a food handler was demonstrated by laboratory tests. METHODS: A retrospective cohort study was designed. Personal or telephone interview was carried out to collect demographic, clinical and microbiological data of the exposed people, as well as food consumption in the suspected lunch. Food handlers of the mentioned summer camp were interviewed.Ten stool samples were requested from symptomatic exposed residents and the three food handlers that prepared the suspected food. Stools were tested for bacteries and noroviruses. Norovirus was detected using RT-PCR and sequence analysis.Attack rate, relative risks (RR) and its 95% confidence intervals (CI) were calculated to assess the association between food consumption and disease. RESULTS: The global attack rate of the outbreak was 55%. The main symptoms were abdominal pain (90%), nausea (85%), vomiting (70%) and diarrhoea (42.5%). The disease remitted in 24-48 hours. Norovirus was detected in seven faecal samples, one of them was from an asymptomatic food handler who had not eaten the suspected food (round of beef), but cooked and served the lunch. Analysis of the two suspected foods isolated no pathogenic bacteria and detected no viruses. Molecular analysis showed that the viral strain was the same in ill patients and in the asymptomatic food handler (genotype GII.2 Melksham-like). CONCLUSIONS: In outbreaks of foodborne disease, the search for viruses in affected patients and all food handlers, even in those that are asymptomatic, is essential. Health education of food handlers with respect to hand washing should be promoted.

Large outbreak of measles in a community with high vaccination coverage: implications for the vaccination schedule.

BACKGROUND: Attempts to eliminate measles from a country or region may be disrupted by an imported case that affects indigenous persons. The objective of this study was to analyze epidemiological and clinical characteristics of a measles outbreak in Catalonia, Spain, in 2006. METHODS: Data on cases of measles reported to the Department of Health, Generalitat of Catalonia, during the period 28 August 2006 through 8 July 2007 were collected. Suspected cases were confirmed by determination of measles-specific immunoglobulin M antibodies and/or detection of virus genome. Incidences were calculated using the estimated population of Catalonia for 2006, and 95% confidence intervals were determined assuming a Poisson distribution. The association between proportions was determined using the chi(2) test and Fisher's exact test. The level of statistical significance was set at alpha = .05. RESULTS: A total of 381 cases were confirmed, for an incidence of 6.6 cases per 100,000 persons. A total of 89.5% of cases occurred in nonvaccinated persons, mainly those aged < or =15 months (incidence, 278.2 cases per 100,000 persons; mean age of patients, 12 months). Indigenous subjects accounted for 89.8% of cases, and laboratory confirmation of results was obtained for 87.1%. Measles genotype D4 was identified in all sequenced samples. CONCLUSIONS: The age distribution of cases of measles among children aged <15 months suggests that the first dose of vaccine should be routinely administered at the age of 12 months.

[Survey of the performance of anti-HIV antibody detection tests in laboratories in Catalonia [Spain]]. / Encuesta sobre la realización de las pruebas de detección de los anticuerpos anti-VIH en los laboratorios de Cataluña.

Quality assurance of HIV testing is essential to correctly assess the HIV epidemic. To describe the characteristics of HIV testing and identify features that could be improved, a questionnaire on the quality of HIV tests was sent to Catalan laboratories in 1998. The survey revealed variability in the procedures used by the participating laboratories when performing HIV tests. Some of the laboratories were still performing incorrect activities such as identifying HIV specimens with specific labels, extracting new specimens for a second test to confirm diagnosis, or failing to guarantee the confidentiality of the results. The criteria for HIV testing should be standardized according to the purpose of the test and the prevalence of the infection in the population analyzed. This approach would improve the quality of the results of diagnostic tests, since the overall concept of quality includes the entire process (pre-test, test and post-test).

Encuesta sobre la realización de las pruebas de detección de los anticuerpos anti-VIH en los laboratorios de Cataluña / Survey of HIV testing in laboratories in Catalonia [Spain]

Para poder interpretar correctamente la epidemia de infección por el VIH, es indispensable garantizar la calidad en la realización del test anti-VIH. Con el objetivo de describir las características durante el proceso analítico e identificar aspectos susceptibles de mejora, en 1998 se realizó una encuesta sobre la garantía de calidad en los laboratorios de Cataluña que realizaban pruebas de detección de anticuerpos anti-VIH. Los resultados de la encuesta muestran la variabilidad de los procesos analíticos llevados a cabo por los diferentes laboratorios para la determinación diagnóstica de anticuerpos anti-VIH. Hay laboratorios que todavía realizan prácticas incorrectas, como identificar especialmente las muestras biológicas VIH, realizar segundas extracciones para pruebas de confirmación y no garantizar la confidencialidad en la entrega de resultados. Sería aconsejable unificar criterios según sea el objetivo de la prueba y la prevalencia de infección en la población analizada. Ello mejoraría la calidad del resultado analítico, ya que el concepto global de calidad incluye todo el proceso (preanalítico, analítico y postanalítico). (AU)

Efectividad de una intervención de deshabituación tabáquica en pacientes con patología cardiovascular / Effectiveness of Smoking Cessation Intervention in Patients with Cardiovascular Disease

Introducción y objetivos. La incidencia de acontecimientos coronarios desciende rápidamente en los pacientes con enfermedad cardíaca que dejan de fumar. Sólo un 50 por ciento de los pacientes que dejan el consumo de tabaco tras un episodio agudo permanecerán abstinentes a los 3 meses del alta hospitalaria. El objetivo del estudio es evaluar la efectividad de un programa de deshabituación tabáquica en pacientes con enfermedad cardiovascular. Métodos. Se estudió una cohorte de fumadores que iniciaron tratamiento deshabituador entre septiembre de 1993 y junio de 1999. Se compararon 348 pacientes con enfermedad cardiovascular con 1.107 sin ningún proceso patológico. Se realizó un seguimiento según el protocolo de 12 meses de duración y se determinó el monóxido de carbono exhalado en cada control para valorar la recaída. Se calculó la abstinencia en cada período y se estimaron las odds ratio para la recaída a los 12 meses. Resultados. Se observó una abstinencia continuada global a los 12 meses del 37,1 por ciento (129/348) entre los enfermos con enfermedad cardiovascular y del 39,6 por ciento (438/1.107) entre los pacientes sin ningún proceso patológico. Los fumadores consonantes (precontemplativos) presentaron un mayor número de recaídas, con una Odds ratio ajustada de 1,36. Conclusiones. En los pacientes con enfermedad cardiovascular de nuestra serie que no pudieron dejar el hábito tabáquico durante su ingreso o después de su diagnóstico, un tratamiento y seguimientos exhaustivos consiguió un porcentaje de abstinencia considerable, por lo que creemos que estos pacientes pueden beneficiarse de las unidades de deshabituación tabáquica (AU)