La enfermedad por virus Zika en España. Resultados de la vigilancia y epidemiología de los casos notificados en 2015-2017 / Zika virus disease in Spain. Surveillance results and epidemiology on reported cases, 2015-2017

Introducción y objetivo: La enfermedad por virus Zika constituye un reto para la salud pública por su rápida expansión y sus potenciales complicaciones fetales. En España la enfermedad por virus Zika es importada, aunque la presencia de Aedes albopictus no descarta su transmisión autóctona. La enfermedad por virus Zika y los casos congénitos se vigilan desde 2016. El objetivo es conocer su epidemiología y el resultado de la gestación en las embarazadas. Material y métodos: Estudio descriptivo de casos notificados a la Red Nacional de Vigilancia Epidemiológica (RENAVE) entre el 30/11/2015 y el 31/12/2017. La definición de caso y la encuesta se recogen en los protocolos de la RENAVE. Las variables fueron: fecha, comunidad autónoma (CC.AA.), clasificación, modo y lugar de infección, variables sociodemográficas, clínicas, microbiológicas, embarazo y su evolución. Se realizó un análisis descriptivo de los casos y su distribución según el resto de variables. Resultados: Diecisiete CC.AA. notificaron 512 casos, de los cuales 507 fueron no congénitos: 327 (64,5%) eran mujeres (52,5% en edad fértil); 403 casos (79,5%) correspondieron a 2016 y 193 (38,1%) residían en CC.AA. colonizadas por A. albopictus entre mayo y octubre. El 96,1% de casos importados se infectaron en América y el 51,7% en visitas familiares. Se detectaron 3 casos de infección congénita en 77 embarazadas. Conclusiones: La evolución de notificaciones mostró paralelismo con la de la epidemia en América. El grupo más numeroso de viajeros fue el de mujeres jóvenes que fueron a Latinoamérica en visitas familiares. El seguimiento de las embarazadas permitió identificar complicaciones fetales

Introduction and objective: Zika virus disease is a challenge for public health due to its rapid spread and potential foetal complications. Although it is imported in Spain, there is a risk of autochthonous transmission due to Aedes albopictus presence. Zika disease and congenital cases have been under surveillance since 2016. The objective of this study is to explore the epidemiology of disease and pregnancies result. Material and methods: A descriptive study was carried out into cases reported to the National Surveillance Network (RENAVE) during the 30/11/2015 to 31/12/2017 period. The case definition and the survey are included in the RENAVE protocol. The variables were: date; notifying region (Autonomous Community (AC)); pregnancy and its evolution; case classification; mode of transmission; country or region of infection; socio-demographical, clinical and microbiological data. A descriptive analysis of the cases and their distribution according to the other variables was carried out. Results: A total of 512 cases were reported by 17 ACs. 507 were non-congenital, of which 327 (64.5%) were women (52.5% of childbearing age). 403 cases (79.5%) corresponded to 2016 and 193 (38.1%) resided in regions with A. albopictus presence between May and October. 96.1% of imported cases were infected in America (51.7% while visiting relatives). Three cases (3.9%) of congenital Zika virus infection were detected among 77 pregnant women. Conclusions: The evolution of reported cases was in accordance with that of the epidemic in America. The largest group of travellers was young women who travelled to Latin America on family visits. Pregnancy monitoring resulted in the identification of Zika related foetal complications

Zika virus disease in Spain. Surveillance results and epidemiology on reported cases, 2015-2017. / La enfermedad por virus Zika en España. Resultados de la vigilancia y epidemiología de los casos notificados en 2015-2017.

INTRODUCTION AND OBJECTIVE: Zika virus disease is a challenge for public health due to its rapid spread and potential foetal complications. Although it is imported in Spain, there is a risk of autochthonous transmission due to Aedes albopictus presence. Zika disease and congenital cases have been under surveillance since 2016. The objective of this study is to explore the epidemiology of disease and pregnancies result. MATERIAL AND METHODS: A descriptive study was carried out into cases reported to the National Surveillance Network (RENAVE) during the 30/11/2015 to 31/12/2017 period. The case definition and the survey are included in the RENAVE protocol. The variables were: date; notifying region (Autonomous Community (AC)); pregnancy and its evolution; case classification; mode of transmission; country or region of infection; socio-demographical, clinical and microbiological data. A descriptive analysis of the cases and their distribution according to the other variables was carried out. RESULTS: A total of 512 cases were reported by 17 ACs. 507 were non-congenital, of which 327 (64.5%) were women (52.5% of childbearing age). 403 cases (79.5%) corresponded to 2016 and 193 (38.1%) resided in regions with A. albopictus presence between May and October. 96.1% of imported cases were infected in America (51.7% while visiting relatives). Three cases (3.9%) of congenital Zika virus infection were detected among 77 pregnant women. CONCLUSIONS: The evolution of reported cases was in accordance with that of the epidemic in America. The largest group of travellers was young women who travelled to Latin America on family visits. Pregnancy monitoring resulted in the identification of Zika related foetal complications.

First autochthonous malaria case due to Plasmodium vivax since eradication, Spain, October 2010.

In October 2010, one case of autochthonous malaria due to Plasmodium vivax was diagnosed in Spain. The case occurred in Aragon, north-eastern Spain, where the vector Anopheles atroparvus is present. Although the source of infection could not be identified, this event highlights that sporadic autochthonous transmission of vector-borne diseases in continental Europe is possible and calls for enhanced surveillance and vector control measures.

Risk factors for disease severity among hospitalised patients with 2009 pandemic influenza A (H1N1) in Spain, April - December 2009.

We describe the clinical and epidemiological characteristics of patients hospitalised with confirmed 2009 pandemic influenza A(H1N1) in Spain from April to December 2009 and the risk factors associated with a worse outcome (admission to an intensive care unit or death) in adults. Case-based epidemiological information was collected as part of the national strategy for the surveillance of severe cases. Of 3,025 patients, 852 were admitted to an intensive care unit and overall, 200 died. The median patient age was 38 years (range: 0­94). A total of 662 (26%) patients had no underlying risk conditions. Antiviral therapy was initiated within 48 hours after symptom onset in only 35.2% (n=711); the median length of time before treatment was four days. In a multivariate analysis, the start of antiviral therapy more than 48 hours after symptom onset (odds ratio (OR) 2.39; 95% confidence interval (CI): 1.79 to 3.2), morbid obesity (OR: 2.01; 95% CI 1.38 to 2.94), cardiovascular disease (OR: 1.79; 95% CI: 1.2 to 2.67) and chronic obstructive pulmonary disease (OR: 1.51; 95% CI: 1.03 to 2.2) were significantly associated with a worse outcome in adults.

Actividades de vigilancia epidemiológica durante la pandemia de gripe (H1N1) 2009 en España. Reflexiones un años después / Epidemiological surveillance activities during the 2009 influenza pandemic in Spain. Lessons learnt one year after

En este artículo se revisan las actuaciones llevadas a cabo en España en materia de vigilancia epidemiológica durante la pandemia de gripe y las recomendaciones de ellas derivadas en los diferentes momentos de la evolución de la misma. El funcionamiento del Sub-comité de Vigilancia, contemplado en el Plan Nacional de Prepara-ción y Respuesta ante una pandemia de gripe, fue clave para la coor-dinación de estas actividades de vigilancia. Este Subcomité se activó de forma inmediata tras la declaración de la alerta y su papel también se describe en este trabajo. La existencia del Plan permitió una respuesta rápida y coordina-da tras la declaración de la alerta. La vigilancia epidemiológica y virológica de la gripe hubo de ir adaptándose a una situación cam-biante, y se pusieron en marcha sistemas adicionales a los de la vigi-lancia habitual de la gripe, tales como la vigilancia individualizada de casos en la comunidad y de casos graves y mortales. Entre las lecciones aprendidas destacan la necesidad de fortale-cer el análisis de los datos que se recogen durante una alerta, la nece-sidad de favorecer el intercambio de información entre los profesio-nales de salud pública y los asistenciales, y de reforzar la capacidad de respuesta para poder disponer de estructuras de salud pública fuertes y consolidadas ante futuras alertas sanitarias(AU)

In this article the actions taken in the area of epidemiological sur-veillance in Spain during the influenza pandemic and the recommen-dations drawn from them during the progression of the pandemic are reviewed. The performance of the Surveillance Subcommittee established in the National Influenza Preparedness and Response Plan was cen-tral to the coordination of these activities. The Surveillance Subcom-mittee was immediately activated when the alert was issued. Its role is also described in this review. The existence of a National Plan allowed a rapid and coordinated response after the alert declaration. The epidemiological and virolo-gical surveillance of the influenza pandemic was adapted to an evol-ving situation. In addition to routine influenza monitoring systems, new surveillance systems were put in place such as a case-based sur-veillance for community influenza cases and a case-based survei-llance for severe cases and deaths due to the pandemic. Among the lessons learned from this pandemic, we would high-light the need to strengthen the timely analysis of data collected during an alert, the need to promote the exchange of information among public health and health care professionals, and to strengthen the response capacity in order to have resilient and consolidated public health structures for future health alerts(AU)

Vigilancia individualizada de los casos iniciales de infección por gripe pandémica (H1N1) 2009 en España, abril-junio 2009 / Enhanced surveillance of initial cases of pandemic influenza (H1N1) 2009 infection in Spain, April-June 2009

Fundamentos: En abril de 2009 se inició en España una nueva estrategia de vigilancia con el objetivo de detectar los casos originados por el virus pandémico (H1N1) 2009 y de implementar las medidas de control adecuadas para contener su transmisión. Se describen las características clínicas y epidemiológicas de los casos confirmados en España notificados por la Red Nacional de Vigilancia Epidemiológica desde el 24 Abril al 30 Junio 2009. Métodos: Como parte de la respuesta inicial de vigilancia a la pandemia, a nivel nacional se recogió información clínica y epide-miológica individualizada de todos los casos en investigación de infección por virus pandémico (H1N1) 2009, así como de sus contactos. Resultados: De los 717 casos confirmados el 91% fueron notificados por 5 Comunidades Autónomas. A 15 de junio de 2009 el 49,1% de los casos pertenecían a brotes en centros educativos. No se detectaron brotes nosocomiales. La mediana de período de incubación fue de 3 días. El 88% de los casos tenía menos de 30 años y el 24,9% eran importados. Los síntomas más frecuentes fueron tos (92%) y fiebre (81,8%). La mediana de duración de síntomas fue de 5 días. Trece casos requirieron ingreso hospitalario y uno falleció. Conclusiones: Durante los primeros meses de pandemia los casos de gripe pandémica presentaron un cuadro leve similar al de la gripe estacional que afectó mayoritariamente a niños y adultos jóvenes. A finales de junio 2009 la aparición de brotes en diferentes colectivos reflejaba la penetración del virus pandémico en la comunidad y el inicio de su circulación(AU)

Background: In April 2009, a new surveillance strategy for the detection of cases of pandemic influenza (H1N1) 2009 infection and for the implementation of appropriate control measures to contain its transmission was initiated in Spain. We describe the clinical and epi-demiological characteristics of confirmed cases in Spain notified by the National Epidemiological Surveillance Network from April 24 to June 30, 2009. Methods: As part of the initial surveillance response to the pan-demic, case-based clinical and epidemiological information was co-llected nationwide on cases under investigation for pandemic virus (H1N1) 2009 infection and their contacts. Results: Of 717 confirmed cases, 91% were notified by 5 Auto-nomous Communities. As of June 15, 49.1% of cases belonged to school outbreaks. No nosocomial outbreaks were detected. The me-dian incubation period was 3 days. Eighty-eight percent of cases were under the age of 30 years, and 24.9% were imported. The most frequent symptoms were cough (92%) and fever (81.8%). The me-dian duration of symptoms was 5 days. Thirteen cases required hos-pitalization and one died. Conclusions: During the first months of the pandemic, pande-mic influenza cases experienced a mild illness similar to seasonal influenza, predominantly affecting children and young adults. By the end of June 2009, the detection of outbreaks in different settings indicated the diffusion of the pandemic virus into the community and the start of its circulation(AU)

Casos de infección por gripe pandémica (H1N1) 2009 hospitalizados en cuidados intensivos en España: factores asociados a riesgo de muerte, abril 2009-enero2010 / Critically ill patients with 2009 pandemic influenza A (H1N1) infection in Spain: factors associated with death, April 2009-January 2010

Fundamento: El análisis de los casos graves de gripe pandémica es necesario para identificar grupos de población vulnerables y adecuar las políticas de prevención y control. Se analizan las características clínicas y epidemiológicas así como los factores asociados a riesgo de muerte en los casos de infección por virus pandémico (H1N1) 2009 hospitalizados en unidades de cuidados intensivos (UCI) en España y notificados entre el 24 de abril de 2009 y el 31 de enero de 2010. Método:En el marco de la estrategia nacional de vigilancia de casos hospitalizados por gripe pandémica, se recogió a nivel nacional informa-ción clínica y epidemiológica individualizada de todos los casos hospitali-zados en UCI por infección por virus pandémico (H1N1) 2009. Resultados:De los 1.231 casos ingresados en una UCI fallecieron 271 (letalidad: 22%). La mediana de edad fue 40 años (rango: 0-90). Un total de 838 (76,3%) pacientes presentaban alguna patología subyacente, siendo la respiratoria la más frecuente (34,1%), seguida en adultos de la obesidad mórbida (18,8%). Un 93,1% recibió tratamiento antiviral y un 25,6% (n=231) lo recibió en 48 horas desde el inicio de síntomas. En el análisis multivariante el cáncer (OR 2,71; IC95% 1,44-5,1), las inmunodeficiencias (OR 2,25; IC95% 1,29-3,92) y la obesidad mórbida (OR 1,79; IC95% 1,13-2,85) estaban asociados significativamente a muerte en los adultos. Conclusión:La caracterización de los casos graves de gripe pandé-mica ha sido clave para identificar como factores de riesgo para sufrir complicaciones y muerte por gripe, la existencia de cáncer e inmunodefi-ciencias y, por primera vez, la obesidad mórbida en personas adultas(AU)

Background: It is necessary to analyse the severe cases of pandemic influenza infection in order to identify vulnerable populations and adapt prevention and control policies accordingly. We analysed the clinical and epidemiological characteristics and risk factors associated with death in patients with 2009 pandemic influenza A (H1N1) infection hospitalised in intensive care units (ICUs) in Spain and reported from 24 April 2009 to 31 January 2010. Methods: As part of the national strategy for surveillance of hospita-lized cases with pandemic influenza, cased-based clinical and epidemiolo-gical information on all cases admitted to an ICU with 2009 pandemic virus (H1N1) infection was collected nationwide. Results: Of 1,231 cases admitted to ICU, 271 died (case fatality ratio, 22%). The median age was 40 years (range: 0-90). A total of 838 (76.3%) patients had an underlying risk condition, being respiratory disease the most frequently reported (34.1%), followed by morbid obesity (18.8%), in adults. Antiviral treatment was given in 93.1% patients and in 25.6% (n = 231) it was initiated within 48 hours of symptoms onset. In a multivariate analysis, cancer (OR 2.71, 95%CI 1.44 to 5.1), immunodeficiency (OR 2.25, 95%CI 1.29 - 3.92) and morbid obesity (OR 1.79, 95%CI 1.13 to 2.85) were significantly associated with death in adults. Conclusions:The characterization of severe pandemic influenza cases has been crucial in identifying as risk factors of complications and death from influenza the presence of cancer and immunodeficiencies and for the first time, morbid obesity in adults(AU)

Brote de gripe pandémica (H1N1) 2009 en una academia militar: inicio de la circulación comunitaria en España / Pandemic influenza (H1N1) 2009 outbreak in a military academy: start of community circulation in Spain

Fundamento: El 19 de mayo de 2009 se declararon 21 casos de soldados con síntomas de infección respiratoria aguda en la Academia Militar de Ingenieros (ACING) en Hoyo de Manzanares, España. En el contexto de una alerta mundial por gripe A(H1N1) 2009, se decide investigar la posible aparición de un brote por este virus. El objetivo es describir un posible brote de gripe (H1N1) 2009 en un Centro de Formación Militar y describir las medidas adoptadas, en la fase de contención, para evitar su transmisión. Métodos: Se administró un cuestionario específico y se recogieron muestras biológicas a todos los casos en investigación. Se recomendaron aislamiento y cuarentena, respectivamente de los casos y contactos. Resultados: Se confirmaron 81 casos de infección por virus de la gripe A (H1N1)2009. De las 52 muestras procesadas 31 fueron positivas para virus influenza A/California/7/2009. La edad media de los casos fue 22,0 años (rango, 18-31). El 84% eran varones. Los síntomas más comunes fueron tos y fiebre. Todos los casos permanecieron aislados y fueron tratados con oseltamivir, con buena evolución. La tasa de ataque global fue 12,42%. Ningún caso tenía antecedentes de viaje a zonas de riesgo o vinculo epidemiológico con un caso diagnosticado previamente fuera de la ACING. Se identificaron 31 casos relacionados con este brote fuera de la ACING, 24 casos eran contactos familiares y amigos. Conclusiones: Este brote alertó del inicio de la circulación comunitaria del virus pandémico en España. La detección precoz del mismo favoreció la puesta en marcha de medidas para la contención de su trasmisión(AU)

Background: On May 19, 2009, 21 cases of influenza-like illness were reported among soldiers from an Engineering Military Academy (ACING) in Hoyo de Manzanares, Spain. In the context of an influenza A (H1N1)2009 global alert, it was decided to investigate a possible pandemic influenza outbreak. To describe a possible outbreak of influenza A (H1N1)2009 in a Military Training Centre and to describe the measures adopted for transmission control of this new infection. Methods: A specific questionnaire was administered and biological samples were collected from all cases under investigation. Isolation and quarantine were recommended for cases and contacts, respectively. Results: Eighty-one cases were confirmed. Among 52 samples tested, 31 were positive for influenza virus A/California/7/2009. The average age of the cases was 22.0 years (range 18-31 years) and 84% were men. Most common reported symptoms were cough and fever. All cases were isolated and treated with oseltamivir, with full recovery. The total attack rate was 12.42%. None of the cases had history of travel to risk areas or contact with previously diagnosed cases outside the academy. Thirty-one confirmed cases related to this outbreak were identified outside the academy, 24 cases were family contacts and friends. Conclusions: This outbreak was the first evidence of community transmission of pandemic influenza H1N1 in Spain. The rapid detection of this outbreak enhanced an early implementation of measures aiming at the containment of its transmission(AU)

[Usefulness of the 14-3-3 test for the diagnosis of sCJD evaluated by a Spanish reference center]. / Utilidad del inmunoensayo de la proteína 14-3-3 en el diagnóstico de la enfermedad de Creutzfeldt-Jakob examinada desde un centro de referencia nacional.

INTRODUCTION: The performance of the 14-3-3 protein test has been shown to be adequate for sporadic Creutzfeldt-Jakob disease (sCJD) diagnosis in selected populations, but its routine validity has been questioned. METHODS: One thousand and sixty-eight patients with clinically suspected sCJD were analyzed in a Spanish reference center. In order to explore the influence of the clinical context on the performance of the immunoassay, the patients were classified at sample reception according to the World Health Organization (WHO) diagnostic criteria excluding the 14-3-3 test results. The yield of the immunoassay was evaluated in each subgroup with criteria of probable, possible sCJD or non-sCJD. RESULTS: In the set of patients with suspicion of sCJD the inclusion of the 14-3-3 test produces a significant increase in the diagnosis certainty (positive likelihood ratio: 10.1) compared to the WHO's criteria, excluding the 14-3-3 test. For patients classified at sample reception as probable sCJD (n=166), possible sCJD (n=129) and non-sCJD (n=773), the positive predictive values for the test were 98.4%, 97.5% and 31%, and the negative predictive values were 22.2%, 73.4% and 100%, respectively. CONCLUSIONS: The predictive values of the assay vary according to the previous diagnostic certainty. Therefore, in order to interpret correctly the test, it is necessary to evaluate the degree of initial clinical suspicion of the patient at the moment of the cerebrospinal fluid (CSF) extraction. This study offers up-to-date information, referenced to the Spanish population, and in useful format, and it is intended to serve as a guideline for 14-3-3 test results interpretation to the clinicians in our community.

Utilidad del inmunoensayo de la proteína 14-3-3 en el diagnóstico de la enfermedad de Creutzfeldt-Jakob examinada desde un centro de referencia nacional / Usefulness of the 14-3-3 test for the diagnosis of sCJD evaluated by a Spanish reference center

Introducción. El inmunoensayo de la proteína 14-3-3 en líquido cefalorraquídeo (LCR) muestra un rendimiento óptimo para el diagnóstico de la enfermedad de Creutzfeldt- Jakob esporádica (ECJe) en poblaciones seleccionadas, pero su validez en la práctica rutinaria ha sido cuestionada. Método. Se estudiaron 1.068 pacientes con sospecha de ECJe procedentes de distintas instituciones españolas. Para explorar la influencia del contexto clínico sobre la validez del inmunoensayo los pacientes fueron clasificados en el momento de la recepción de la muestra de acuerdo con los criterios de certeza diagnóstica establecidos por la Organización Mundial de la Salud (OMS), excluyendo la prueba de la proteína 14-3-3. El rendimiento del immunoensayo se evaluó en cada subgrupo con criterios de ECJe probable, posible o no ECJe. Resultados. En el conjunto de pacientes con sospecha de ECJe la inclusión del inmunoensayo supone un aumento significativo en la certeza diagnóstica (razón de verosimilitud positiva: 10,1) sobre los criterios de la OMS sin incluir dicha prueba. En los subgrupos de pacientes clasificados a la recepción de la muestra como ECJe probable (n=166), ECJe posible (n=129) y no ECJe (n=773) los valores predictivos positivos de la prueba de la proteína 14-3-3 fueron 98,4, 97,5 y 31% y los valores predictivos negativos fueron 22,2, 73,4 y 100%, respectivamente. Conclusiones. Los valores predictivos de la prueba varían según el grado de certeza diagnóstica previa de cada paciente. Por ello, para interpretar correctamente el ensayo es necesario valorar el grado de sospecha clínica del paciente en el momento de la extracción del LCR. Este estudio pretende facilitar la interpretación de los resultados de la prueba de la proteína 14-3-3 a los especialistas clínicos, ofreciendo una información actualizada, referenciada a la población española y en formato de utilidad práctica (AU)

Introduction: The performance of the 14-3-3 protein test has been shown to be adequate for sporadic Creutzfeldt-Jakob disease (sCJD) diagnosis in selected populations, but its routine validity has been questioned. Methods: One thousand and sixty-eight patients with clinically suspected sCJD were analyzed in a Spanish reference center. In order to explore the influence of the clinical context on the performance of the immunoassay, the patients were classified at sample reception according to the World Health Organization (WHO) diagnostic criteria excluding the 14-3-3 test results. The yield of the immunoassay was evaluated in each subgroup with criteria of probable, possible sCJD or non-sCJD. Results: In the set of patients with suspicion of sCJD the inclusion of the 14-3-3 test produces a significant increase in the diagnosis certainty (positive likelihood ratio: 10.1) compared to the WHO's criteria, excluding the 14-3-3 test. For patients classified at sample reception as probable sCJD (n=166), possible sCJD (n=129) and non-sCJD (n=773), the positive predictive values for the test were 98.4%, 97.5% and 31%, and the negative predictive values were 22.2%, 73.4% and 100%, respectively. Conclusions: The predictive values of the assay vary according to the previous diagnostic certainty. Therefore, in order to interpret correctly the test, it is necessary to evaluate the degree of initial clinical suspicion of the patient at the moment of the cerebrospinal fluid (CSF) extraction. This study offers up-to-date information, referenced to the Spanish population, and in useful format, and it is intended to serve as a guideline for 14-3-3 test results interpretation to the clinicians in our community (AU)

Influenza vaccination coverages among Spanish children, adults and health care workers.

BACKGROUND: This study aimed at describing influenza vaccination coverage among Spanish children, adults and health care workers (HCWs). PATIENTS AND METHODS: We analyzed 27,791 questionnaires on subjects aged 6 months or over, drawn from the 2003 Spanish National Health Survey. As the dependent variable, we took the answer to the question, "Did you (or your child) have a flu shot in the last campaign?". Independent variables were age group, gender, nationality, occupation (HCWs) and coexistence of chronic conditions. RESULTS: Overall influenza vaccination coverage for the total sample was 19.58%. Coverage for the pediatric population was 5.55%, with 20.74% of those with and 4.67% of those without chronic condition being vaccinated. Vaccination coverages were: 63.7% among subjects aged > or = 65 years; 30.5% among high-risk subjects aged < 65 years; and 19.65% among HCWs. CONCLUSIONS: We conclude that the available results show low levels of influenza vaccination coverage among high-risk subjects aged under 65 years, children in particular, and HCWs.

[Costs of accidental punctures in hospital health personnel]. / Costes de las inoculaciones accidentales en personal sanitario de un hospital.

OBJECTIVES: The aim of this study was to calculate the average cost of each hepatitis B, C and HIV follow-up carried out in the health personnel that have suffered an exposure to blood and body fluids and to estimate the cost for each of the different types of sources as well as to identify the items that account for the main part of the cost. METHODS: A cost analysis was carried out. The post-exposure programme was modelled in a decision tree combining probabilities (percentage of each type of source in dependence of its positivity for the three viruses and immunization state of the health personnel against hepatitis B) and monetary costs (pesetas from 1994). Costs included: salaries, laboratory, chemist, energy, cleaning, telephone, medical and office equipment, amortization and lost productivity. A sensitivity analysis was carried out with the real fulfillment of the programme. RESULTS: The average cost was 39,564 ptas. (29,750 ptas. applying the sensitivity analysis), with a range from 86,864 ptas. (source positive for the three viruses and injured subject not immunized) to 23,074 ptas. (source negative for the three viruses). If the source was hepatitis B positive, the average cost was 86,093 ptas. when the injured subject was not immunized and 53,232 ptas. if he was immunized. Serologic tests account for the main part of the cost (range from 72.8% to 87.7%). CONCLUSIONS: High cost suggests an appropriate risk evaluation in order to avoid unnecessary follow-ups. The model used allows to know the cost of each potentially avoided episode and it could be used for any hospital in order to make an economical evaluation of new preventive devices.

[Minimizing the costs of prescription of anti-infective drugs in two areas of primary health care]. / Un estudio de minimización de costes en la prescripción de antiinfecciosos en dos areas de atención primaria.

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was pesetas 8.547 bn in 1995. Expenditure on selected anti-infective drugs was pesetas 522 million (6.1% of the total). The overall saving estimated was 7.63% (pesetas 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.