1
|
Gómez VJ, Martín-González A, Zafra-Vallejo V, Zubillaga-Rodríguez I, Fernández-García A, Sánchez-Aniceto G. Controversies in point-of-care 3D printing for oncological and reconstructive surgery with free software in oral and maxillofacial surgery: European regulations, costs, and timeframe. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00007-9. [PMID: 38290865 DOI: 10.1016/j.ijom.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/01/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Abstract
The aim of this paper is to discuss the controversies surrounding the most recent European regulations, as well as the cost, for a 3D printing workflow using free-source software in the context of a tertiary level university hospital in the Spanish public health system. Computer-aided design and manufacturing (CAD/CAM) for head and neck oncological surgery with the printing of biomodels, cutting guides, and patient-specific implants has made it possible to simplify and make this type of highly complex surgery more predictable. This technology is not without drawbacks, such as increased costs and the lead times when planning with the biomedical industry. A review of the current European legislation and the literature on this subject was performed, and comparisons made with the authors' in-house 3D printing setup using free software and different 3D printers. The cost analysis revealed that for the cheapest setup with free software, it would be possible to amortize the investment from case 2, and in all cases the initial investment would be amortized before case 9. The timeframe ranged from 2 weeks with the biomedical industry to 72 h with point-of-care 3D printing. It is now possible to develop point-of-care 3D printing in any hospital with almost any budget.
Collapse
Affiliation(s)
- V J Gómez
- Oral and Maxillofacial Surgery Department, 12 de Octubre University Hospital, Madrid, Spain.
| | - A Martín-González
- Engineering Department, 3D Printing Point-of-Care Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - V Zafra-Vallejo
- Oral and Maxillofacial Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - I Zubillaga-Rodríguez
- Oral and Maxillofacial Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - A Fernández-García
- Oral and Maxillofacial Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - G Sánchez-Aniceto
- Oral and Maxillofacial Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| |
Collapse
|
2
|
Gavilán AM, Perán-Ramos P, Sanz JC, García-Comas L, Pérez-Abeledo M, Castellanos AM, Berciano JM, López-Perea N, Masa-Calles J, Echevarría JE, Fernández-García A. Investigating Local Patterns of Mumps Virus Circulation, Using a Combination of Molecular Tools. Viruses 2023; 15:2420. [PMID: 38140661 PMCID: PMC10747990 DOI: 10.3390/v15122420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Mumps is a vaccine-preventable disease caused by the mumps virus (MuV). However, MuV has re-emerged in many countries with high vaccine coverage. The World Health Organization (WHO) recommends molecular surveillance based on sequencing of the small hydrophobic (SH) gene. Additionally, the combined use of SH and non-coding regions (NCR) has been described in different studies, proving to be a useful complement marker to discriminate general patterns of circulation at national and international levels. The aim of this work is to test local-level usefulness of the combination of SH and MF-NCR sequencing in tracing hidden transmission clusters and chains during the last epidemic wave (2015-2020) in Spain. A database with 903 cases from the Autonomous Community of Madrid was generated by the integration of microbiological and epidemiological data. Of these, 453 representative cases were genotyped. Eight different SH variants and thirty-four SH haplotypes were detected. Local MuV circulation showed the same temporal pattern previously described at a national level. Only two of the thirteen previously identified outbreaks were caused by more than one variant/haplotype. Geographical representation of SH variants allowed the identification of several previously undetected clusters, which were analysed phylogenetically by the combination of SH and MF-NCR, in a total of 90 cases. MF-NCR was not able to improve the discrimination of geographical clusters based on SH sequencing, showing limited resolution for outbreak investigations.
Collapse
Affiliation(s)
- Ana M. Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
| | - Paula Perán-Ramos
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
| | - Juan Carlos Sanz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, 28055 Madrid, Spain;
| | - Luis García-Comas
- Servicio de Epidemiología, Consejería de Sanidad de la Comunidad de Madrid, 28009 Madrid, Spain;
| | - Marta Pérez-Abeledo
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, 28055 Madrid, Spain;
| | - Ana M. Castellanos
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
| | - José M. Berciano
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ, 28049 Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan E. Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
| |
Collapse
|
3
|
Gavilán AM, van de Nes-Reijnen L, Castellanos A, Woudenberg T, López-Perea N, Masa-Calles J, Echevarría JE, Fernández-García A, Bodewes R. Comparison of circulation patterns of mumps virus in the Netherlands and Spain (2015-2020). Front Microbiol 2023; 14:1207500. [PMID: 37396375 PMCID: PMC10311905 DOI: 10.3389/fmicb.2023.1207500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Background Mumps is a viral infection mainly characterized by inflammation of the parotid glands. Despite of vaccination programs, infections among fully vaccinated populations were reported. The World Health Organization (WHO) recommends molecular surveillance of mumps based on sequencing of the small hydrophobic (SH) gene. The use of hypervariable non-coding regions (NCR) as additional molecular markers was proposed in multiple studies. Circulation of mumps virus (MuV) genotypes and variants in different European countries were described in the literature. From 2010 to 2020, mumps outbreaks caused by genotype G were described. However, this issue has not been analyzed from a wider geographical perspective. In the present study, sequence data from MuV detected in Spain and in The Netherlands during a period of 5 years (2015- March 2020) were analyzed to gain insights in the spatiotemporal spread of MuV at a larger geographical scale than in previous local studies. Methods A total of 1,121 SH and 262 NCR between the Matrix and Fusion protein genes (MF-NCR) sequences from both countries were included in this study. Analysis of SH revealed 106 different haplotypes (set of identical sequences). Results Of them, seven showing extensive circulation were considered variants. All seven were detected in both countries in coincident temporal periods. A single MF-NCR haplotype was detected in 156 sequences (59.3% of total), and was shared by five of the seven SH variants, as well as three minor MF-NCR haplotypes. All SH variants and MF-NCR haplotypes shared by both countries were detected first in Spain. Discussion Our results suggest a transmission way from south to north Europe. The higher incidence rate of mumps in Spain in spite of similar immunization coverage in both countries, could be associated with higher risk of MuV exportation. In conclusion, the present study provided novel insights into the circulation of MuV variants and haplotypes beyond the borders of single countries. In fact, the use of MF-NCR molecular tool allowed to reveal MuV transmission flows between The Netherlands and Spain. Similar studies including other (European) countries are needed to provide a broader view of the data presented in this study.
Collapse
Affiliation(s)
- Ana M. Gavilán
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Linda van de Nes-Reijnen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Ana Castellanos
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Tom Woudenberg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Juan E. Echevarría
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Aurora Fernández-García
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Rogier Bodewes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| |
Collapse
|
4
|
Jacqueline C, Gavilán AM, López-Perea N, Penedos AR, Masa-Calles J, Echevarría JE, Fernández-García A. Utility of MF-non coding region for measles molecular surveillance during post-elimination phase, Spain, 2017-2020. Front Microbiol 2023; 14:1143933. [PMID: 37283922 PMCID: PMC10240958 DOI: 10.3389/fmicb.2023.1143933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background In countries entering the post-elimination phase for measles, the study of variants by sequencing of 450 nucleotides of the N gene (N450) does not always allow the tracing of chains of transmission. Indeed, between 2017 and 2020, most measles virus sequences belonged to either the MVs/Dublin.IRL/8.16 (B3-Dublin) or the MVs/Gir Somnath.IND/42.16 (D8-Gir Somnath) variants. We evaluated the additional use of a non-coding region (MF-NCR) as a tool to enhance resolution and infer case origin, chains of transmission and characterize outbreaks. Methods We obtained 115 high-quality MF-NCR sequences from strains collected from Spanish patients infected with either B3-Dublin or D8-Gir Somnath variants between 2017 and 2020, performed epidemiological, phylogenetic and phylodynamic analyses and applied a mathematical model to determine relatedness among identified clades. Results Applying this model allowed us to identify phylogenetic clades potentially derived from concomitant importations of the virus rather than single chain of transmission, inferred based on only N450 and epidemiology data. In a third outbreak, we found two related clades that corresponded to two chains of transmission. Discussion Our results show the ability of the proposed method to improve identification of simultaneous importations in the same region which could trigger enhanced contact tracing. Moreover, the identification of further transmission chains indicates that the size of import-related outbreaks was smaller than previously found, supporting the interpretation that endemic measles transmission was absent in Spain between 2017 and 2020. We suggest considering the use of the MF-NCR region in conjunction with the study of N450 variants in future WHO recommendations for measles surveillance.
Collapse
Affiliation(s)
- Camille Jacqueline
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Ana María Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan E. Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | |
Collapse
|
5
|
Pastor-Barriuso R, Pérez-Gómez B, Oteo-Iglesias J, Hernán MA, Pérez-Olmeda M, Fernández-de-Larrea N, Molina M, Fernández-García A, Martín M, Cruz I, Sanmartín JL, León-Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R, Pollán M. Design and Implementation of a Nationwide Population-Based Longitudinal Survey of SARS-CoV-2 Infection in Spain: The ENE-COVID Study. Am J Public Health 2023; 113:525-532. [PMID: 36893375 PMCID: PMC10088947 DOI: 10.2105/ajph.2022.307167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 03/11/2023]
Abstract
Data System. The Spanish National Seroepidemiological Survey of SARS-CoV-2 (or ENE-COVID; SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2] is the causative agent of COVID-19) was funded by the Spanish Ministry of Health, the Instituto de Salud Carlos III, and the Spanish National Health System. Data Collection/Processing. A stratified 2-stage probability sampling was used to select a representative cohort of the noninstitutionalized population of Spain. ENE-COVID collected longitudinal data from epidemiological questionnaires and 2 SARS-CoV-2 IgG antibody tests. From April 27 to June 22, 2020, 68 287 participants (77.0% of contacted persons) received a point-of-care test and 61 095 (68.9%) also underwent a laboratory immunoassay. A second follow-up phase was conducted between November 16 and 30, 2020. Data Analysis/Dissemination. Analyses use weights to adjust for oversampling and nonresponse and account for design effects of stratification and clustering. ENE-COVID data for research purposes will be available upon request from the official study Web page. Public Health Implications. ENE-COVID, a nationwide population-based study, allowed monitoring seroprevalence of antibodies against SARS-CoV-2 at the national and regional levels, providing accurate figures by gender, age (from babies to nonagenarians), and selected risk factors; characterizing symptomatic and asymptomatic infections; and estimating the infection fatality risk during the first pandemic wave. (Am J Public Health. 2023;113(5):525-532. https://doi.org/10.2105/AJPH.2022.307167).
Collapse
Affiliation(s)
- Roberto Pastor-Barriuso
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Beatriz Pérez-Gómez
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Jesús Oteo-Iglesias
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Miguel A Hernán
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mayte Pérez-Olmeda
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Nerea Fernández-de-Larrea
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Marta Molina
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Aurora Fernández-García
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mariano Martín
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Israel Cruz
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José L Sanmartín
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José León-Paniagua
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Juan F Muñoz-Montalvo
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Faustino Blanco
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Raquel Yotti
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Marina Pollán
- Roberto Pastor-Barriuso, Beatriz Pérez-Gómez, Nerea Fernández-de-Larrea, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Jesús Oteo-Iglesias, Mayte Pérez-Olmeda, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Marta Molina, Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| |
Collapse
|
6
|
Pérez-Gómez B, Pastor-Barriuso R, Fernández-de-Larrea N, Hernán MA, Pérez-Olmeda M, Oteo-Iglesias J, Fernández-Navarro P, Fernández-García A, Martín M, Cruz I, Sanmartín JL, León-Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R, Pollán M. SARS-CoV-2 Infection During the First and Second Pandemic Waves in Spain: the ENE-COVID Study. Am J Public Health 2023; 113:533-544. [PMID: 36893370 PMCID: PMC10088950 DOI: 10.2105/ajph.2023.307233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 03/11/2023]
Abstract
Objectives. To describe participant characteristics associated with severe acute respiratory syndrome coronavirus 2 infection in Spain's first 2 COVID-19 waves per the Spanish National Seroepidemiological Survey of SARS-CoV-2 Infection (ENE-COVID). Methods. A representative cohort of the noninstitutionalized Spanish population, selected through stratified 2-stage sampling, answered a questionnaire and received point-of-care testing April to June 2020 (first wave: n = 68 287); previously seronegative participants repeated the questionnaire and test November 2020 (second wave: n = 44 451). We estimated seropositivity by wave and participant characteristics, accounting for sampling weights, nonresponse, and design effects. Results. We found that 6.0% (95% confidence interval [CI] = 5.7%, 6.4%) of Spain's population was infected by June and 3.8% (95% CI = 3.5%, 4.1%) more by November 2020. Both genders were equally affected. Seroprevalence decreased with age in adults 20 years and older in the second wave; socioeconomic differences increased. Health care workers were affected at 11.1% (95% CI = 9.0%, 13.6%) and 6.1% (95% CI = 4.4%, 8.5%) in the first and second waves, respectively. Living with an infected person increased infection risk to 22.1% (95% CI = 18.9%, 25.6%) in the first and 35.0% (95% CI = 30.8%, 39.4%) in the second wave. Conclusions. ENE-COVID characterized the first 2 pandemic waves, when information from surveillance systems was incomplete. (Am J Public Health. 2023;113(5):533-544. https://doi.org/10.2105/AJPH.2023.307233).
Collapse
Affiliation(s)
- Beatriz Pérez-Gómez
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Roberto Pastor-Barriuso
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Nerea Fernández-de-Larrea
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Miguel A Hernán
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mayte Pérez-Olmeda
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Jesús Oteo-Iglesias
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Pablo Fernández-Navarro
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Aurora Fernández-García
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Mariano Martín
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Israel Cruz
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José L Sanmartín
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - José León-Paniagua
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Juan F Muñoz-Montalvo
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Faustino Blanco
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Raquel Yotti
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| | - Marina Pollán
- Beatriz Pérez-Gómez, Roberto Pastor-Barriuso, Nerea Fernández-de-Larrea, Pablo Fernández-Navarro, and Marina Pollán are with the National Centre for Epidemiology and the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain. Miguel A. Hernán is with the Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. Mayte Pérez-Olmeda, Jesús Oteo-Iglesias, and Aurora Fernández-García are with the National Centre for Microbiology and the Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), ISCIII. Mariano Martín, José L. Sanmartín, Juan F. Muñoz-Montalvo, and Faustino Blanco are with the Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain. Israel Cruz is with the National School of Public Health, ISCIII. José León-Paniagua and Raquel Yotti are with ISCIII
| |
Collapse
|
7
|
Pampaka D, López-Perea N, Fernández-García A, Huertas-Zarco I, Castellanos-Martínez M, Villatoro-Bongiorno K, Roig-Sena J, Torner N, Mar Mosquera M, Echevarría JE, Prats JF, Masa-Calles J. An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018. Euro Surveill 2023; 28. [PMID: 37103785 DOI: 10.2807/1560-7917.es.2023.28.17.2200634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Given sustained high vaccination coverage and enhanced surveillance for measles, Spain has been free of endemic measles transmission since 2014, achieving elimination certification from the World Health Organization in 2017. In November 2017, measles was introduced through an imported case travelling to the Valencian Community, causing an interregional outbreak. Here, we describe the outbreak using data reported to the national epidemiological surveillance network. The outbreak involved 154 cases (67 males, 87 females) notified in four regions; 148 were laboratory-confirmed and six epidemiologically linked. Most cases were adults aged 30-39 (n = 62, 40.3%) years. Sixty-two cases were hospitalised (40.3%) and 35 presented complications (22.7%). Two thirds of the cases (n = 102) were unvaccinated including 11 infants (≤ 1 year) not yet eligible for vaccination. The main route of transmission was nosocomial; at least six healthcare facilities and 41 healthcare workers and support personnel were affected. Sequencing of the viral nucleoprotein C-terminus (N450) identified genotype B3, belonging to the circulating MVs/Dublin.IRL/8.16-variant. Control measures were implemented, and the outbreak was contained in July 2018. The outbreak highlighted that raising awareness about measles and improving the vaccination coverage in under-vaccinated subgroups and personnel of healthcare facilities are key measures for prevention of future outbreaks.
Collapse
Affiliation(s)
- Despina Pampaka
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Huertas-Zarco
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Maite Castellanos-Martínez
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Katja Villatoro-Bongiorno
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Javier Roig-Sena
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Nuria Torner
- Universitat de Barcelona, Barcelona, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - María Mar Mosquera
- Microbiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Juan Emilio Echevarría
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Josefa Masa-Calles
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
8
|
Fernández-Ferro M, Fernández-González V, Salgado-Barreira Á, Santos-Armentia E, Valdés-Sarmiento P, Fernández-García A, Gómez-Rey D, Fernández-Sanromán J. Correlation between the main clinical, imaging, and arthroscopy findings in patients with temporomandibular disorders. Int J Oral Maxillofac Surg 2023; 52:237-244. [PMID: 35985912 DOI: 10.1016/j.ijom.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023]
Abstract
The purpose of this work was to prospectively correlate the most characteristic clinical symptoms of temporomandibular disorders, such as pain and limitation of mouth opening, with the findings of magnetic resonance imaging (disc position, degenerative changes, and effusion) and arthroscopy findings (roofing, synovitis, chondromalacia, adhesions, and perforations). These examinations were performed in 298 patients diagnosed with internal derangement refractory to conservative treatment. The mean age of the patients was 38.59 years; 92.6% were female. The t-test and one-way analysis of variance (ANOVA) were used to correlate the findings. Significant relationships were found between pain and disc displacement without reduction (P = 0.033) and effusion (P = 0.003) on MRI, coinciding with correlations between pain and roofing of 0-25% (P = 0.016) and synovitis (P = 0.001) on arthroscopy. A significant relationship was also observed between mouth opening limitation and the presence of osteoarthrosis (P = 0.018) on MRI, and between mouth opening limitation and synovitis (P = 0.022), chondromalacia (P = 0.002), and adhesions (P < 0.001) on arthroscopy. All of these findings were observed in patients with a poor initial clinical situation, which highlights the considerable potential of correlating these data with imaging and arthroscopy findings.
Collapse
Affiliation(s)
- M Fernández-Ferro
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain; Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain; Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain.
| | - V Fernández-González
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain
| | - Á Salgado-Barreira
- Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain
| | - E Santos-Armentia
- Department of Radiology, Ribera Povisa Hospital, Vigo, Pontevedra, Spain
| | - P Valdés-Sarmiento
- Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain
| | - A Fernández-García
- Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain
| | - D Gómez-Rey
- Department of Family Medicine and Community Health, Santiago de Compostela University Clinical Hospital, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - J Fernández-Sanromán
- Department of Oral and Maxillofacial Surgery, Ribera Povisa Hospital, Vigo, Pontevedra, Spain; Povisa University School of Nursing, University of Vigo, Vigo, Pontevedra, Spain; Galicia Sur Health Research Institute, Álvaro Cunqueiro Hospital, University of Vigo, Vigo, Pontevedra, Spain
| |
Collapse
|
9
|
Gavilán AM, Díez-Fuertes F, Sanz JC, Castellanos AM, López-Perea N, Jiménez SM, Ruiz-Sopeña C, Masa-Calles J, García-Comas L, de Ory F, Pérez-Olmeda M, Fernández-García A, Echevarría JE. Increase of Diversity of Mumps Virus Genotype G SH Variants Circulating Among a Highly Immunized Population: Spain, 2007-2019. J Infect Dis 2022; 227:151-160. [PMID: 35524966 DOI: 10.1093/infdis/jiac176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/19/2023] Open
Abstract
MuV caused three epidemic waves in Spain since genotype G emerged in 2005, despite high vaccination coverage. SH gene sequencing according to WHO protocols allowed the identification of seven relevant variants and 88 haplotypes. While the originally imported MuVi/Sheffield.GBR/1.05/-variant prevailed during the first two waves, it was subsequently replaced by other variants originated by either local evolution or importation, according to the additional analysis of hypervariable NCRs. The time of emergence of the MRCA of each MuV variant clade was concordant with the data of the earliest sequence. The analysis of Shannon entropy showed an accumulation of variability on six particular positions as the cause of the increase on the number of circulating SH variants. Consequently, SH gene sequencing needs to be complemented with other more variable markers for mumps surveillance immediately after the emergence of a new genotype, but the subsequent emergence of new SH variants turns it unnecessary.
Collapse
Affiliation(s)
- A M Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - F Díez-Fuertes
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - J C Sanz
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Madrid, Spain
| | - A M Castellanos
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - N López-Perea
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - S M Jiménez
- Servicio de Microbiología, Hospital de Segovia, Segovia, Spain
| | - C Ruiz-Sopeña
- Servicio de Epidemiología, Consejería de Sanidad de Castilla y León, Valladolid, Spain
| | - J Masa-Calles
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - L García-Comas
- Servicio de Epidemiología, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
| | - F de Ory
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - M Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - A Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - J E Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| |
Collapse
|
10
|
Fernández-García A, Pérez-Ríos M, Fernández-Villar A, Candal-Pedreira C, Naveira-Barbeito G, Santiago-Pérez MI, Rey-Brandariz J, Represas-Represas C, Malvar-Pintos A, Ruano-Ravina A. Hospitalizations due to and with chronic obstructive pulmonary disease in Galicia: 20 years of evolution. Rev Clin Esp 2022; 222:569-577. [PMID: 35882597 DOI: 10.1016/j.rceng.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This work aims to analyze the evolution of COPD-related hospitalizations in Galicia from 1996 to 2018 both as main cause of admission (DUE TO COPD) or when coded in any diagnostic order (WITH COPD), assessing the influence of age, sex, seasonality, and other main causes of the hospitalization. METHODS An analysis was conducted of administrative healthcare database (CMBD) data on index COPD-related hospitalizations in Galicia from 1996 to 2018. Crude, specific, and standardized rates were calculated for the entire sample and according to age and sex groups. RESULTS In the period from 1996 to 2018, there were 310,883 index admissions WITH COPD in Galicia, of which 29.6% were DUE TO COPD. Both WITH COPD and DUE TO COPD admission rates increased, mainly in men. There was a clear seasonality that was especially relevant in the DUE TO COPD group. The mean male-to-female ratio was approximately 4:1 in both groups, although it was lower in the extreme age groups, with no change over time. The mean age at admission increased three years in men during this period; there were no changes among women. The main causes of admission in those not hospitalized DUE TO COPD were heart failure and pneumonia. CONCLUSION The combined evaluation of records of hospital admissions WITH COPD and DUE TO COPD offers additional information for a better understanding of the trends of this disease and allows for establishing hypotheses that explain the results described, providing information for better healthcare planning.
Collapse
Affiliation(s)
- A Fernández-García
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Hospital POVISA, Vigo, Pontevedra, Spain
| | - M Pérez-Ríos
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain.
| | - A Fernández-Villar
- Servicio de Neumología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - C Candal-Pedreira
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - G Naveira-Barbeito
- Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - M I Santiago-Pérez
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - J Rey-Brandariz
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - C Represas-Represas
- Servicio de Neumología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - A Malvar-Pintos
- Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - A Ruano-Ravina
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain
| |
Collapse
|
11
|
González-Praetorius A, Fernández-García A, Pérez-Olmeda M, García-Rivera MV, Caballero-López B, Gilaberte-Reyzabal S, Román-Marcos E, Ory-Machón FD, Echevarría-Mayo JE. Measles outbreak in the sanitary area of Guadalajara (Spain): difficulty in microbiological diagnosis in the era of its elimination. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:532-538. [PMID: 35811250 DOI: 10.1016/j.eimce.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tolos for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in two that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or two vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS The combination of molecular tests and the presence of specific IgM is necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.
Collapse
Affiliation(s)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M Victoria García-Rivera
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, Spain
| | | | | | - Elena Román-Marcos
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, Spain
| | - Fernando de Ory-Machón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Emilio Echevarría-Mayo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
12
|
Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Evaluation of the detection of specific IgM against measles virus by the chemiluminescence immunoassay Liaison® Measles IgM. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:523-524. [PMID: 35729050 DOI: 10.1016/j.eimce.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Belén Ramos
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain
| | - Mayte Pérez-Olmeda
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
13
|
Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Reply to "Modified measles outbreak in vaccinated healthcare workers exposed to primary measles case". Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:344-345. [PMID: 35491354 DOI: 10.1016/j.eimce.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Belén Ramos
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain
| | - Mayte Pérez-Olmeda
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Spain; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
14
|
Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Réplica a «Brote de sarampión-modificado en personal sanitario tras exposición a un caso de sarampión clásico». Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
15
|
Fernández-García A, Pérez-Ríos M, Fernández-Villar A, Candal-Pedreira C, Naveira-Barbeito G, Santiago-Pérez M, Rey-Brandariz J, Represas-Represas C, Malvar-Pintos A, Ruano-Ravina A. Hospitalizaciones por y con enfermedad pulmonar obstructiva crónica en Galicia: 20 años de evolución. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
16
|
Penedos AR, Fernández-García A, Lazar M, Ralh K, Williams D, Brown KE. Mind your Ps: A probabilistic model to aid the interpretation of molecular epidemiology data. EBioMedicine 2022; 79:103989. [PMID: 35398788 PMCID: PMC9006250 DOI: 10.1016/j.ebiom.2022.103989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 02/18/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022] Open
Abstract
Background Assessing relatedness of pathogen sequences in clinical samples is a core goal in molecular epidemiology. Tools for Bayesian analysis of phylogeny, such as the BEAST software package, have been typically used in the analysis of sequence/time data in public health. However, they are computationally-, time-, and knowledge-intensive, demanding resources that many laboratories do not have available or cannot allocate frequently. Methods To evaluate a faster and simpler alternative method to support the routine interpretation of sequence data for epidemiology, we obtained sequences for two regions in the measles virus genome, N-450 and MF-NCR, from patient samples of genotypes B3, D4 and D8 taken between 2011 and 2017 in the UK and Romania. A mathematical model incorporating time, possible shared ancestry and the Poisson distribution describing the number of expected substitutions at a given time point was developed to exclude epidemiological relatedness between pairs of sequences. The model was validated against the commonly used Bayesian phylogenetic method using an independent dataset collected in 2017–19. Findings We demonstrate that our model, using time and sequence information to predict whether two samples may be related within a given time frame, minimises the risk of erroneous exclusion of relatedness. An easy-to-use implementation in the form of a guide and spreadsheet is provided for convenient application. Interpretation The proposed model only requires a previously calculated substitution rate for the locus and pathogen of interest. It allows for an informed but quick decision on the likelihood of relatedness between two samples within a time frame, without the need for phylogenetic reconstruction, thus facilitating rapid epidemiological interpretation of sequence data. Funding This work was funded by the United Kingdom Health Security Agency (UKHSA). The World Health Organization European Regional Office funded Aurora Fernández-García and Mihaela Lazar training visits to UKHSA.
Collapse
|
17
|
Aragón A, Velasco MJ, Gavilán AM, Fernández-García A, Sanz JC. Mumps virus outbreak related to a water pipe (narghile) shared smoking. Enferm Infecc Microbiol Clin (Engl Ed) 2021; 39:503-505. [PMID: 34531159 DOI: 10.1016/j.eimce.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/05/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION This study describes a mumps outbreak among a group of young people who shared a same narghile to smoking. Saliva and blood samples were obtained from 3 cases for RT-PCR and serology respectively. METHODS The notification of a mumps case started an epidemiological investigation. Information of other 6 additional symptomatic persons who had gathered with the case in a discotheque where they smoking in a same narghile was achieved. RT-PCR positive samples were genotyped by sequencing. RESULTS The 7 patients resided in 3 different municipalities, and they do not have get together for more than a month until the meeting in the discotheque. Four cases were confirmed by RT-PCR and/or IgM determinations. The genomic investigation showed identical nucleic sequences. CONCLUSIONS This outbreak is consequence of the common use of a narghile to smoking. The public usage of these water pipes should be regulated.
Collapse
Affiliation(s)
- Andrés Aragón
- Unidad Técnica 8 del Área de Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid. Spain.
| | - Manuel José Velasco
- Unidad Técnica 8 del Área de Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid. Spain
| | - Ana M Gavilán
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Sanz
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain
| |
Collapse
|
18
|
López-Perea N, Fernández-García A, Echevarría JE, de Ory F, Pérez-Olmeda M, Masa-Calles J. Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014-2020. Viruses 2021; 13:v13101982. [PMID: 34696412 PMCID: PMC8537497 DOI: 10.3390/v13101982] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.
Collapse
Affiliation(s)
- Noemí López-Perea
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
| | - Aurora Fernández-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- Correspondence:
| | - Juan Emilio Echevarría
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Fernando de Ory
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain
| | - Josefa Masa-Calles
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
| |
Collapse
|
19
|
Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Evaluación de la detección de IgM específica frente a sarampión mediante el ensayo de inmunoquimioluminiscencia Liaison® Measles IgM. Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
González-Praetorius A, Fernández-García A, Pérez-Olmeda M, García-Rivera MV, Caballero-López B, Gilaberte-Reyzabal S, Román-Marcos E, de Ory-Machón F, Echevarría-Mayo JE. Measles outbreak in the sanitary area of Guadalajara (Spain): Difficulty in microbiological diagnosis in the era of its elimination. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00232-9. [PMID: 34429225 DOI: 10.1016/j.eimc.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS The combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.
Collapse
Affiliation(s)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
| | - M Victoria García-Rivera
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | | | | | - Elena Román-Marcos
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | - Fernando de Ory-Machón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Juan Emilio Echevarría-Mayo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| |
Collapse
|
21
|
Pérez-Gómez B, Pastor-Barriuso R, Pérez-Olmeda M, Hernán MA, Oteo-Iglesias J, Fernández de Larrea N, Fernández-García A, Martín M, Fernández-Navarro P, Cruz I, Sanmartín JL, León Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R, Pollán M. ENE-COVID nationwide serosurvey served to characterize asymptomatic infections and to develop a symptom-based risk score to predict COVID-19. J Clin Epidemiol 2021; 139:240-254. [PMID: 34126206 PMCID: PMC8192836 DOI: 10.1016/j.jclinepi.2021.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022]
Abstract
Objectives To characterize asymptomatic SARS-CoV-2 infections and develop a symptom-based risk score useful in primary healthcare. Study design and setting Sixty-one thousand ninty-two community-dwelling participants in a nationwide population-based serosurvey completed a questionnaire on COVID-19 symptoms and received an immunoassay for SARS-CoV-2 IgG antibodies between April 27 and June 22, 2020. Standardized prevalence ratios for asymptomatic infection were estimated across participant characteristics. We constructed a symptom-based risk score and evaluated its ability to predict SARS-CoV-2 infection. Results Of all, 28.7% of infections were asymptomatic (95% CI 26.1–31.4%). Standardized asymptomatic prevalence ratios were 1.19 (1.02–1.40) for men vs. women, 1.82 (1.33–2.50) and 1.45 (0.96–2.18) for individuals <20 and ≥80 years vs. those aged 40–59, 1.27 (1.03–1.55) for smokers vs. nonsmokers, and 1.91 (1.59–2.29) for individuals without vs. with case contact. In symptomatic population, a symptom-based score (weights: severe tiredness = 1; absence of sore throat = 1; fever = 2; anosmia/ageusia = 5) reached standardized seroprevalence ratio of 8.71 (7.37–10.3), discrimination index of 0.79 (0.77–0.81), and sensitivity and specificity of 71.4% (68.1–74.4%) and 74.2% (73.1–75.2%) for a score ≥3. Conclusion The presence of anosmia/ageusia, fever with severe tiredness, or fever without sore throat should serve to suspect COVID-19 in areas with active viral circulation. The proportion of asymptomatics in children and adolescents challenges infection control.
Collapse
Affiliation(s)
- Beatriz Pérez-Gómez
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Ctra de Pozuelo 28, 28222 Madrid, Spain
| | - Miguel A Hernán
- Departments of Epidemiology and Biostatistics, Harvard T H Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology, 677 Huntington Ave, Boston, MA 02115, USA
| | - Jesús Oteo-Iglesias
- National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Ctra de Pozuelo 28, 28222 Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Nerea Fernández de Larrea
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Aurora Fernández-García
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; National Centre for Microbiology, Instituto de Salud Carlos III (ISCIII), Ctra de Pozuelo 28, 28222 Madrid, Spain
| | - Mariano Martín
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Pablo Fernández-Navarro
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Jose L Sanmartín
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Jose León Paniagua
- Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Juan F Muñoz-Montalvo
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Faustino Blanco
- Deputy Directorate of Information Technologies, Ministry of Health, Paseo del Prado 18, 28014 Madrid, Spain
| | - Raquel Yotti
- Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain
| | - Marina Pollán
- National Centre for Epidemiology, Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Monforte de Lemos 5, 28029 Madrid, Spain.
| | | |
Collapse
|
22
|
Pastor-Barriuso R, Pérez-Gómez B, Hernán MA, Pérez-Olmeda M, Yotti R, Oteo-Iglesias J, Sanmartín JL, León-Gómez I, Fernández-García A, Fernández-Navarro P, Cruz I, Martín M, Delgado-Sanz C, Fernández de Larrea N, León Paniagua J, Muñoz-Montalvo JF, Blanco F, Larrauri A, Pollán M. Infection fatality risk for SARS-CoV-2 in community dwelling population of Spain: nationwide seroepidemiological study. BMJ 2020; 371:m4509. [PMID: 33246972 PMCID: PMC7690290 DOI: 10.1136/bmj.m4509] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate the infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on deaths with confirmed coronavirus disease 2019 (covid-19) and excess deaths from all causes. DESIGN Nationwide seroepidemiological study. SETTING First wave of covid-19 pandemic in Spain. PARTICIPANTS Community dwelling individuals of all ages. MAIN OUTCOME MEASURES The main outcome measure was overall, and age and sex specific, infection fatality risk for SARS-CoV-2 (the number of covid-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections) in the community dwelling Spanish population. Deaths with laboratory confirmed covid-19 were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all cause deaths from the Monitoring Mortality System (MoMo), up to 15 July 2020. SARS-CoV-2 infections in Spain were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61 098 participants in the ENE-COVID nationwide seroepidemiological survey between 27 April and 22 June 2020. RESULTS The overall infection fatality risk was 0.8% (19 228 of 2.3 million infected individuals, 95% confidence interval 0.8% to 0.9%) for confirmed covid-19 deaths and 1.1% (24 778 of 2.3 million infected individuals, 1.0% to 1.2%) for excess deaths. The infection fatality risk was 1.1% (95% confidence interval 1.0% to 1.2%) to 1.4% (1.3% to 1.5%) in men and 0.6% (0.5% to 0.6%) to 0.8% (0.7% to 0.8%) in women. The infection fatality risk increased sharply after age 50, ranging from 11.6% (8.1% to 16.5%) to 16.4% (11.4% to 23.2%) in men aged 80 or more and from 4.6% (3.4% to 6.3%) to 6.5% (4.7% to 8.8%) in women aged 80 or more. CONCLUSION The increase in SARS-CoV-2 infection fatality risk after age 50 appeared to be more noticeable in men than in women. Based on the results of this study, fatality from covid-19 was greater than that reported for other common respiratory diseases, such as seasonal influenza.
Collapse
Affiliation(s)
- Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint first authors
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint first authors
| | - Miguel A Hernán
- Departments of Epidemiology and Biostatistics, Harvard TH Chan School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Jesús Oteo-Iglesias
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
- Spanish Network for Research in Infectious Diseases (REIPI), Institute of Health Carlos III, Madrid, Spain
| | | | - Inmaculada León-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Pablo Fernández-Navarro
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain
| | | | - Concepción Delgado-Sanz
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Nerea Fernández de Larrea
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | | | | | - Amparo Larrauri
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint senior authors
| | - Marina Pollán
- National Centre for Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Joint senior authors
| |
Collapse
|
23
|
Aragón A, Velasco MJ, Gavilán AM, Fernández-García A, Sanz JC. Mumps virus outbreak related to a water pipe (narghile) shared smoking. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30283-4. [PMID: 33059946 PMCID: PMC7550116 DOI: 10.1016/j.eimc.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 12/05/2022]
Abstract
INTRODUCTION This study describes a mumps outbreak among a group of young people who shared a same narghile to smoking. Saliva and blood samples were obtained from 3cases for RT-PCR and serology respectively. METHODS The notification of a mumps case started an epidemiological investigation. Information of other 6additional symptomatic persons who had gathered with the case in a discotheque where they smoking in a same narghile was achieved. RT-PCR positive samples were genotyped by sequencing. RESULTS The 7patients resided in 3different municipalities, and they do not have get together for more than a month until the meeting in the discotheque. Four cases were confirmed by RT-PCR and/or IgM determinations. The genomic investigation showed identical nucleic sequences. CONCLUSIONS This outbreak is consequence of the common use of a narghile to smoking. The public usage of these water pipes should be regulated.
Collapse
Affiliation(s)
- Andrés Aragón
- Unidad Técnica 8 del Área de Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, España.
| | - Manuel José Velasco
- Unidad Técnica 8 del Área de Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, España
| | - Ana M Gavilán
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - Aurora Fernández-García
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - Juan Carlos Sanz
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España; Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, España
| |
Collapse
|
24
|
Pollán M, Pérez-Gómez B, Pastor-Barriuso R, Oteo J, Hernán MA, Pérez-Olmeda M, Sanmartín JL, Fernández-García A, Cruz I, Fernández de Larrea N, Molina M, Rodríguez-Cabrera F, Martín M, Merino-Amador P, León Paniagua J, Muñoz-Montalvo JF, Blanco F, Yotti R. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet 2020; 396:535-544. [PMID: 32645347 PMCID: PMC7336131 DOI: 10.1016/s0140-6736(20)31483-5] [Citation(s) in RCA: 1148] [Impact Index Per Article: 287.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level. METHODS 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75·1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FINDINGS Seroprevalence was 5·0% (95% CI 4·7-5·4) by the point-of-care test and 4·6% (4·3-5·0) by immunoassay, with a specificity-sensitivity range of 3·7% (3·3-4·0; both tests positive) to 6·2% (5·8-6·6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3·1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87·6% (81·1-92·1; both tests positive) to 91·8% (86·3-95·3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15·3% (13·8-16·8) to 19·3% (17·7-21·0). Around a third of seropositive participants were asymptomatic, ranging from 21·9% (19·1-24·9) to 35·8% (33·1-38·5). Only 19·5% (16·3-23·2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test. INTERPRETATION The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave. FUNDING Spanish Ministry of Health, Institute of Health Carlos III, and Spanish National Health System.
Collapse
Affiliation(s)
- Marina Pollán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.
| | - Beatriz Pérez-Gómez
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Jesús Oteo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Institute of Health Carlos III, Madrid, Spain
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA
| | - Mayte Pérez-Olmeda
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Jose L Sanmartín
- Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain
| | - Aurora Fernández-García
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain; Department of Clinical Microbiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Israel Cruz
- National School of Public Health, Institute of Health Carlos III, Madrid, Spain
| | - Nerea Fernández de Larrea
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Marta Molina
- General Secretary of Health, Ministry of Health, Madrid, Spain
| | | | - Mariano Martín
- Deputy Directorate of Information Technologies, Ministry of Health, Madrid, Spain
| | | | | | | | - Faustino Blanco
- General Secretary of Health, Ministry of Health, Madrid, Spain
| | - Raquel Yotti
- Directorate, Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
25
|
Sanz JC, Fernández-García A, Echevarría JE, de Ory F. Valuation of a commercialized RT-PCR kit for the diagnosis of infection caused by the measles virus. Enferm Infecc Microbiol Clin 2020; 39:155-156. [PMID: 32591202 DOI: 10.1016/j.eimc.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, España; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España.
| | - Aurora Fernández-García
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | - Juan Emilio Echevarría
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | - Fernando de Ory
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| |
Collapse
|
26
|
Gavilán AM, Fernández-García A, Rueda A, Castellanos A, Masa-Calles J, López-Perea N, Torres de Mier MV, de Ory F, Echevarría JE. Genomic non-coding regions reveal hidden patterns of mumps virus circulation in Spain, 2005 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29667574 PMCID: PMC6836197 DOI: 10.2807/1560-7917.es.2018.23.15.17-00349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since mumps vaccination was introduced in 1981 in Spain, the incidence of the disease has dropped significantly. However, cyclic epidemic waves and outbreaks still occur, despite high vaccination coverage. The World Health Organization (WHO) recommends genotyping to trace the pattern of mumps virus (MuV) circulation. Genotype H was predominant in Spain, but was replaced in 2005 by genotype G which has subsequently remained dominant. Of the small hydrophobic protein gene sequences, 78% are identical and belong to the MuVi/ Sheffield.GBR.1.05/[G]-variant. Aim: Our study aimed to investigate whether the circulation of MuV strains in Spain was continuous after the emergence of genotype G in 2005. Method: We obtained 46 samples from Spanish patients infected with MuVi/Sheffield.GBR.1.05/[G] during two epidemic waves and analysed them using new molecular markers based on genomic non-coding regions (NCRs) that discriminate subvariants of this virus strain. Results: Phylogenetic analyses of the nucleoprotein–phosphoprotein and matrix protein–fusion protein NCR indicated strain replacement after a drop in incidence in 2009, which had not been detectable by SH sequencing. Clustering of sequences from patients epidemiologically linked in the same outbreak suggests a potential use for these NCRs in outbreak characterisation. Conclusion: We suggest to consider their use in conjunction with the SH gene in the future WHO recommendations for MuV epidemiological surveillance.
Collapse
Affiliation(s)
- Ana M Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aurora Fernández-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Angel Rueda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana Castellanos
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María V Torres de Mier
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando de Ory
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Juan E Echevarría
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| |
Collapse
|
27
|
Cilleruelo MJ, Fernández-García A, Villaverde S, Echevarría J, Marín MÁ, Sanz JC, López A, Royuela A, Antoran BR, de Ory F. Duration of immunity to measles, rubella and mumps during the first year of life. Vaccine 2019; 37:4164-4171. [DOI: 10.1016/j.vaccine.2019.05.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/13/2019] [Accepted: 05/19/2019] [Indexed: 11/17/2022]
|
28
|
Delgado E, Benito S, Montero V, Cuevas MT, Fernández-García A, Sánchez-Martínez M, García-Bodas E, Díez-Fuertes F, Gil H, Cañada J, Carrera C, Martínez-López J, Sintes M, Pérez-Álvarez L, Thomson MM. Diverse Large HIV-1 Non-subtype B Clusters Are Spreading Among Men Who Have Sex With Men in Spain. Front Microbiol 2019; 10:655. [PMID: 31001231 PMCID: PMC6457325 DOI: 10.3389/fmicb.2019.00655] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/15/2019] [Indexed: 11/23/2022] Open
Abstract
In Western Europe, the HIV-1 epidemic among men who have sex with men (MSM) is dominated by subtype B. However, recently, other genetic forms have been reported to circulate in this population, as evidenced by their grouping in clusters predominantly comprising European individuals. Here we describe four large HIV-1 non-subtype B clusters spreading among MSM in Spain. Samples were collected in 9 regions. A pol fragment was amplified from plasma RNA or blood-extracted DNA. Phylogenetic analyses were performed via maximum likelihood, including database sequences of the same genetic forms as the identified clusters. Times and locations of the most recent common ancestors (MRCA) of clusters were estimated with a Bayesian method. Five large non-subtype B clusters associated with MSM were identified. The largest one, of F1 subtype, was reported previously. The other four were of CRF02_AG (CRF02_1; n = 115) and subtypes A1 (A1_1; n = 66), F1 (F1_3; n = 36), and C (C_7; n = 17). Most individuals belonging to them had been diagnosed of HIV-1 infection in the last 10 years. Each cluster comprised viruses from 3 to 8 Spanish regions and also comprised or was related to viruses from other countries: CRF02_1 comprised a Japanese subcluster and viruses from 8 other countries from Western Europe, Asia, and South America; A1_1 comprised viruses from Portugal, United Kingom, and United States, and was related to the A1 strain circulating in Greece, Albania and Cyprus; F1_3 was related to viruses from Romania; and C_7 comprised viruses from Portugal and was related to a virus from Mozambique. A subcluster within CRF02_1 was associated with heterosexual transmission. Near full-length genomes of each cluster were of uniform genetic form. Times of MRCAs of CRF02_1, A1_1, F1_3, and C_7 were estimated around 1986, 1989, 2013, and 1983, respectively. MRCA locations for CRF02_1 and A1_1 were uncertain (however initial expansions in Spain in Madrid and Vigo, respectively, were estimated) and were most probable in Bilbao, Spain, for F1_3 and Portugal for C_7. These results show that the HIV-1 epidemic among MSM in Spain is becoming increasingly diverse through the expansion of diverse non-subtype B clusters, comprising or related to viruses circulating in other countries.
Collapse
Affiliation(s)
- Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Benito
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Montero
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María Teresa Cuevas
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mónica Sánchez-Martínez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena García-Bodas
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Díez-Fuertes
- AIDS Immunopathogenesis Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Horacio Gil
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,European Program for Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Javier Cañada
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Carrera
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Martínez-López
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Marcos Sintes
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Lucía Pérez-Álvarez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Michael M Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | | |
Collapse
|
29
|
García-Martínez I, Fernández-Álvarez U, Fernández-Ardura T, Fernández-García A, de Juan-Marín M, Pérez-Arias A. Review of catastrophic hand diagnosis over 15 years in a tertiary hospital: do we make proper use of the term? Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:35-40. [PMID: 30482515 DOI: 10.1016/j.recot.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/18/2018] [Accepted: 06/26/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the characteristics of patients diagnosed with 'catastrophic hand' by the plastic surgery department in a tertiary hospital in the period between 2000-2015, analyse the evolution of the use of the term 'catastrophic hand' and conduct a review of the literature with a view to proposing the optimal definition for said expression. MATERIAL AND METHOD We conducted a descriptive and retrospective study of patients diagnosed with 'catastrophic hand' who required hospital care by the plastic surgery department of a tertiary hospital in the period between 2000-2015. We conducted a literature review on the use of the term 'catastrophic hand' and we applied the classifications proposed in the publications consulted to our results. RESULTS The number of 'catastrophic hand' diagnoses was 133. We observed a downward trend in the use of the term over the years. Applying classifications based on the impossibility of recovery of an acceptable hand (presence of three long fingers and thumb) by reconstructive procedures, only 9 out of 133 patients could be considered to have 'catastrophic hands', constituting 6.7% of the total cases. DISCUSSION The term 'catastrophic hand' has different meanings, and this generates ambiguity. The use of a classification based on the possibility of obtaining an acceptable hand diminishes its use and improves the approach for such injuries. CONCLUSION We advocate limiting the use of 'catastrophic hand' to cases that meet criteria of 'mutilated hand' and 'metacarpal hand' to avoid indiscriminate use of the term and optimise therapeutic management.
Collapse
Affiliation(s)
- I García-Martínez
- Departamento de Cirugía Plástica, Estética y Reparadora, Fundación Hospital de Jove, Gijón, España.
| | | | | | | | - M de Juan-Marín
- Departamento de Cirugía Plástica, Estética y Reparadora, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Pérez-Arias
- Departamento de Cirugía, Universidad de Oviedo, Oviedo, España; Departamento de Cirugía Plástica, Estética y Reparadora, Hospital Universitario Central de Asturias, Oviedo, España
| |
Collapse
|
30
|
Seppälä EM, López-Perea N, Torres de Mier MDV, Echevarría JE, Fernández-García A, Masa-Calles J. Last cases of rubella and congenital rubella syndrome in Spain, 1997-2016: The success of a vaccination program. Vaccine 2018; 37:169-175. [PMID: 30454948 DOI: 10.1016/j.vaccine.2018.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/28/2018] [Accepted: 11/07/2018] [Indexed: 11/15/2022]
Abstract
With a highly immunized population, rubella infection in Spain is so low that the WHO has declared the elimination of rubella. Rubella in pregnant women is also very rare. The objective of this study is to describe the last cases of congenital rubella syndrome reported and recommend actions to maintain the status of the disease as eliminated. The CRS cases reported to the Spanish National Epidemiological Surveillance Network between 1997 and 2016 were studied, and the epidemiological, clinical, diagnostic and maternal characteristics of newborns with CRS described. The incidence of CRS was calculated using Birth Statistics from the Spanish National Statistics Agency (INE). Twenty-three cases of CRS were reported, 70% of which were associated with rubella outbreaks. The most common clinical conditions were heart disease (52.2%), deafness (39.1%) and cataracts (30.4%); 91.3% of cases were confirmed by laboratory testing. 70.0% were born from a non-vaccinated foreign mother, resident in Spain (cumulative rate incidence (CR): 1.1/100,000 births), with mothers coming from Africa (36.0%), Latin America (29.0%), Eastern Europe (21.0%) and Asia (14.0%). Six were born to Spanish mothers (CR: 0.08/ 100,000 births), the last of which were in 2005. The majority of CRS cases were born to unvaccinated immigrant women infected in Spain during rubella outbreaks. Universal vaccination in childhood is the most efficient strategy to prevent rubella. The limited circulation of the virus will, however, quickly lead to a loss of awareness about rubella among clinicians and epidemiologists. It is necessary to maintain protocols capable of identifying signs consistent with rubella in pregnant women and signs suggestive of congenital rubella in newborns.
Collapse
Affiliation(s)
| | - Noemí López-Perea
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - María de Viarce Torres de Mier
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - Juan E Echevarría
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220, Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - Aurora Fernández-García
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220, Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - Josefa Masa-Calles
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| |
Collapse
|
31
|
Gil H, Fernández-García A, Mosquera MM, Hübschen JM, Castellanos AM, de Ory F, Masa-Calles J, Echevarría JE. Measles virus genotype D4 strains with non-standard length M-F non-coding region circulated during the major outbreaks of 2011-2012 in Spain. PLoS One 2018; 13:e0199975. [PMID: 30011283 PMCID: PMC6047782 DOI: 10.1371/journal.pone.0199975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
In recent decades, vaccination has substantially reduced the number of measles cases to levels close to the elimination stage. However, major measles outbreaks occurred in Europe during 2010-2012, after the introduction of the D4-Enfield lineage. We have performed a molecular characterization of 75 measles virus genotype D4 strains from patients infected in Spain between 2004 and 2012 by sequencing the N-450 region and the M-F non-coding region (M-F NCR) in order to identify genetic features of these viruses. The analysis of the N-450 region confirmed that all samples obtained since 2008 belonged to variants or sets of identical sequences of the D4-Enfield lineage, including a new one named MVs/Madrid.ESP/46.10/. Analysis of the M-F NCR showed insertions and deletions associated with previously described, uncommon non-standard genome length measles viruses. This genetic feature was identified in the D4-Enfield lineage viruses, but not in the other D4 viruses that were circulating in Spain before 2008, suggesting that these non-standard length M-F NCR sequences are characteristic of the D4-Enfield lineage. The results of the phylogenetic analysis of Spanish M-F NCRs suggest higher resolution in discriminating strains than did the N-450 analysis. In addition, the results of the analysis of the M-F NCR on the MVs/Madrid.ESP/46.10/ sub-lineage seem to support the potential utility of this region as a tool for epidemiological surveillance complementary to the N-450 region, as previously suggested. Further investigation on this question, as well as the surveillance of new potentially emerging strains with non-standard length M-F NCR are strongly recommended as part of future strategies for measles elimination.
Collapse
Affiliation(s)
- Horacio Gil
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Aurora Fernández-García
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - María Mar Mosquera
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Judith M. Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Ana M. Castellanos
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fernando de Ory
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan E. Echevarría
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
32
|
López-Perea N, Masa-Calles J, Torres de Mier MDV, Fernández-García A, Echevarría JE, De Ory F, Martínez de Aragón MV. Shift within age-groups of mumps incidence, hospitalizations and severe complications in a highly vaccinated population. Spain, 1998-2014. Vaccine 2017; 35:4339-4345. [PMID: 28687402 DOI: 10.1016/j.vaccine.2017.06.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Abstract
The mumps vaccine (Jeryl-Lynn-strain) was introduced in Spain in 1981, and a vaccination policy which included a second dose was added in 1995. From 1992-1999, a Rubini-strain based vaccine was administered in many regions but later withdrawn due to lack of effectiveness. Despite high levels of vaccination coverage, epidemics have continued to appear. We characterized the three epidemic waves of mumps between 1998 and 2014, identifying major changes in susceptible populations using Poisson regression. For the period 1998-2003 (P1), the most affected group was from 1 to 4years old (y) [Incidence Rate (IR)=71.7 cases/100,000 population]; in the periods 2004-2009 (P2) and 2010-2014 (P3) IR ratio (IRR) increased among 15-24y (P2=1.46; P3=2.68) and 25-34y (P2=2.17; P3=4.05). Hospitalization rate (HR), complication rate (CR) and neurological complication rate (NR) among hospitalized subjects decreased across the epidemics, except for 25-34y which increased: HR ratio (HRR) (P2=2.18; P3=2.16), CRR (P3=2.48), NRR (P3=2.41). In Spain mumps incidence increased, while an overall decrease of hospitalizations and severe complications occurred across the epidemics. Cohorts born during periods of low vaccination coverage and those vaccinated with Rubini-strain were the most affected populations, leading to a shift in mumps cases from children to adolescents and young adults; this also reveals the waning immunity provided by the mumps vaccine. Despite not preventing all mumps cases, the vaccine appears to prevent serious forms of the disease.
Collapse
Affiliation(s)
- Noemí López-Perea
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Josefa Masa-Calles
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - María de Viarce Torres de Mier
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Aurora Fernández-García
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Juan E Echevarría
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Fernando De Ory
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - María Victoria Martínez de Aragón
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| |
Collapse
|
33
|
Patiño-Galindo JA, Thomson MM, Pérez-Álvarez L, Delgado E, Cuevas MT, Fernández-García A, Nájera R, Iribarren JA, Cilla G, López-Soria L, Lezaun MJ, Cisterna R, González-Candelas F. Transmission dynamics of HIV-1 subtype B in the Basque Country, Spain. Infect Genet Evol 2016; 40:91-97. [PMID: 26921800 DOI: 10.1016/j.meegid.2016.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/15/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
This work was aimed to study the HIV-1 subtype B epidemics in the Basque Country, Spain. 1727 HIV-1 subtype B sequences comprising protease and reverse transcriptase (PR/RT) coding regions, sampled between 2001 and 2008, were analyzed. 156 transmission clusters were detected by means of phylogenetic analyses. Most of them comprised less than 4 individuals and, in total, they included 441 patients. Six clusters comprised 10 or more patients and were further analyzed in order to study their origin and diversification. Four clusters included men who had unprotected homosexual sex (MSM), one group was formed by intravenous drug users (IDUs), and another included both IDUs and people infected through unprotected heterosexual sex (HTs). Most of these clusters originated from the mid-1980s to the mid-1990s. Only one cluster, formed by MSM, originated after 2000. The time between infections was significantly lower in MSM groups than in those containing IDUs (P-value <0.0001). Nucleoside RT and non-nucleoside RT inhibitor (NRTI and NNRTI)-resistance mutations to antiretroviral treatment were found in these six clusters except the most recent MSM group, but only the IDU clusters presented protease inhibitor (PI)-resistance mutations. The most prevalent mutations for each inhibitor class were PI L90M, NRTI T215D/Y/F, and NNRTI K103N, which were also among the most prevalent resistant variants in the whole dataset. In conclusion, while most infections occur as isolated introductions into the population, the number of infections found to be epidemiologically related within the Basque Country is significant. Public health control measures should be reinforced to prevent the further expansion of transmission clusters and resistant mutations occurring within them.
Collapse
Affiliation(s)
- J A Patiño-Galindo
- Joint Research Unit "Infection and Public Health" FISABIO-Universitat de Valencia, Spain; CIBER in Epidemiology and Public Health, Madrid, Spain
| | - Michael M Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María Teresa Cuevas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aurora Fernández-García
- CIBER in Epidemiology and Public Health, Madrid, Spain; Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Rafael Nájera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Gustavo Cilla
- Hospital Universitario Donostia, San Sebastián, Spain; CIBER for Respiratory Diseases, Madrid, Spain
| | | | | | | | - F González-Candelas
- Joint Research Unit "Infection and Public Health" FISABIO-Universitat de Valencia, Spain; CIBER in Epidemiology and Public Health, Madrid, Spain.
| | | |
Collapse
|
34
|
Fernández-García A, Delgado E, Cuevas MT, Vega Y, Montero V, Sánchez M, Carrera C, López-Álvarez MJ, Miralles C, Pérez-Castro S, Cilla G, Hinojosa C, Pérez-Álvarez L, Thomson MM. Identification of an HIV-1 BG Intersubtype Recombinant Form (CRF73_BG), Partially Related to CRF14_BG, Which Is Circulating in Portugal and Spain. PLoS One 2016; 11:e0148549. [PMID: 26900693 PMCID: PMC4765764 DOI: 10.1371/journal.pone.0148549] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/19/2016] [Indexed: 02/06/2023] Open
Abstract
HIV-1 exhibits a characteristically high genetic diversity, with the M group, responsible for the pandemic, being classified into nine subtypes, 72 circulating recombinant forms (CRFs) and numerous unique recombinant forms (URFs). Here we characterize the near full-length genome sequence of an HIV-1 BG intersubtype recombinant virus (X3208) collected in Galicia (Northwest Spain) which exhibits a mosaic structure coincident with that of a previously characterized BG recombinant virus (9601_01), collected in Germany and epidemiologically linked to Portugal, and different from currently defined CRFs. Similar recombination patterns were found in partial genome sequences from three other BG recombinant viruses, one newly derived, from a virus collected in Spain, and two retrieved from databases, collected in France and Portugal, respectively. Breakpoint coincidence and clustering in phylogenetic trees of these epidemiologically-unlinked viruses allow to define a new HIV-1 CRF (CRF73_BG). CRF73_BG shares one breakpoint in the envelope with CRF14_BG, which circulates in Portugal and Spain, and groups with it in a subtype B envelope fragment, but the greatest part of its genome does not appear to derive from CRF14_BG, although both CRFs share as parental strain the subtype G variant circulating in the Iberian Peninsula. Phylogenetic clustering of partial pol and env segments from viruses collected in Portugal and Spain with X3208 and 9691_01 indicates that CRF73_BG is circulating in both countries, with proportions of around 2–3% Portuguese database HIV-1 isolates clustering with CRF73_BG. The fact that an HIV-1 recombinant virus characterized ten years ago as a URF has been shown to represent a CRF suggests that the number of HIV-1 CRFs may be much greater than currently known.
Collapse
Affiliation(s)
- Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María Teresa Cuevas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Yolanda Vega
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Vanessa Montero
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Mónica Sánchez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Cristina Carrera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Celia Miralles
- Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | - Gustavo Cilla
- Hospital Universitario Donostia, San Sebastián, Spain
| | - Carmen Hinojosa
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M. Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail:
| |
Collapse
|
35
|
Delgado E, Cuevas MT, Domínguez F, Vega Y, Cabello M, Fernández-García A, Pérez-Losada M, Castro MÁ, Montero V, Sánchez M, Mariño A, Álvarez H, Ordóñez P, Ocampo A, Miralles C, Pérez-Castro S, López-Álvarez MJ, Rodríguez R, Trigo M, Diz-Arén J, Hinojosa C, Bachiller P, Hernáez-Crespo S, Cisterna R, Garduño E, Pérez-Álvarez L, Thomson MM. Phylogeny and Phylogeography of a Recent HIV-1 Subtype F Outbreak among Men Who Have Sex with Men in Spain Deriving from a Cluster with a Wide Geographic Circulation in Western Europe. PLoS One 2015; 10:e0143325. [PMID: 26599410 PMCID: PMC4658047 DOI: 10.1371/journal.pone.0143325] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 11/03/2015] [Indexed: 11/18/2022] Open
Abstract
We recently reported the rapid expansion of an HIV-1 subtype F cluster among men who have sex with men (MSM) in the region of Galicia, Northwest Spain. Here we update this outbreak, analyze near full-length genomes, determine phylogenetic relationships, and estimate its origin. For this study, we used sequences of HIV-1 protease-reverse transcriptase and env V3 region, and for 17 samples, near full-length genome sequences were obtained. Phylogenetic analyses were performed via maximum likelihood. Locations and times of most recent common ancestors were estimated using Bayesian inference. Among samples analyzed by us, 100 HIV-1 F1 subsubtype infections of monophyletic origin were diagnosed in Spain, including 88 in Galicia and 12 in four other regions. Most viruses (n = 90) grouped in a subcluster (Galician subcluster), while 7 from Valladolid (Central Spain) grouped in another subcluster. At least 94 individuals were sexually-infected males and at least 71 were MSM. Seventeen near full-length genomes were uniformly of F1 subsubtype. Through similarity searches and phylogenetic analyses, we identified 18 viruses from four other Western European countries [Switzerland (n = 8), Belgium (n = 5), France (n = 3), and United Kingdom (n = 2)] and one from Brazil, from samples collected in 2005–2011, which branched within the subtype F cluster, outside of both Spanish subclusters, most of them corresponding to recently infected individuals. The most probable geographic origin and age of the Galician subcluster was Ferrol, Northwest Galicia, around 2007, while the Western European cluster probably emerged in Switzerland around 2002. In conclusion, a recently expanded HIV-1 subtype F cluster, the largest non-subtype B cluster reported in Western Europe, continues to spread among MSM in Spain; this cluster is part of a larger cluster with a wide geographic circulation in diverse Western European countries.
Collapse
Affiliation(s)
- Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María Teresa Cuevas
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Francisco Domínguez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Yolanda Vega
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Marina Cabello
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aurora Fernández-García
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Marcos Pérez-Losada
- Centro de Investigação em Biodiversidade e Recursos Genéticos (CIBIO-InBIO), Vairão, Portugal
| | - María Ángeles Castro
- Department of Internal Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Vanessa Montero
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Mónica Sánchez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Department of Internal Medicine, Complejo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Hortensia Álvarez
- Infectious Diseases Unit, Department of Internal Medicine, Complejo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Patricia Ordóñez
- Department of Microbiology, Complejo Hospitalario Universitario Arquitecto Marcide, Ferrol, A Coruña, Spain
| | - Antonio Ocampo
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Celia Miralles
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Sonia Pérez-Castro
- Department of Microbiology, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | | | - Raúl Rodríguez
- Department of Internal Medicine, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Matilde Trigo
- Department of Microbiology, Complejo Hospitalario Provincial de Pontevedra, Pontevedra, Spain
| | - Julio Diz-Arén
- Department of Internal Medicine, Complejo Hospitalario Provincial de Pontevedra, Pontevedra, Spain
| | - Carmen Hinojosa
- Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Bachiller
- Department of Internal Medicine, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Silvia Hernáez-Crespo
- Department of Clinical Microbiology and Infection Control, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Ramón Cisterna
- Department of Clinical Microbiology and Infection Control, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Eugenio Garduño
- Department of Microbiology, Hospital Infanta Cristina, Badajoz, Spain
| | - Lucía Pérez-Álvarez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail:
| |
Collapse
|
36
|
Vega Y, Delgado E, Fernández-García A, Cuevas MT, Thomson MM, Montero V, Sánchez M, Sánchez AM, Pérez-Álvarez L. Epidemiological Surveillance of HIV-1 Transmitted Drug Resistance in Spain in 2004-2012: Relevance of Transmission Clusters in the Propagation of Resistance Mutations. PLoS One 2015; 10:e0125699. [PMID: 26010948 PMCID: PMC4444345 DOI: 10.1371/journal.pone.0125699] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/21/2015] [Indexed: 11/18/2022] Open
Abstract
Our objectives were to carry out an epidemiological surveillance study on transmitted drug resistance (TDR) among individuals newly diagnosed of HIV-1 infection during a nine year period in Spain and to assess the role of transmission clusters (TC) in the propagation of resistant strains. An overall of 1614 newly diagnosed individuals were included in the study from January 2004 through December 2012. Individuals come from two different Spanish regions: Galicia and the Basque Country. Resistance mutations to reverse transcriptase inhibitors (RTI) and protease inhibitors (PI) were analyzed according to mutations included in the surveillance drug-resistance mutations list updated in 2009. TC were defined as those comprising viruses from five or more individuals whose sequences clustered in maximum likelihood phylogenetic trees with a bootstrap value ≥90%. The overall prevalence of TDR to any drug was 9.9%: 4.9% to nucleoside RTIs (NRTIs), 3.6% to non-nucleoside RTIs (NNRTIs), and 2.7% to PIs. A significant decrease of TDR to NRTIs over time was observed [from 10% in 2004 to 2% in 2012 (p=0.01)]. Sixty eight (42.2%) of 161 sequences with TDR were included in 25 TC composed of 5 or more individuals. Of them, 9 clusters harbored TDR associated with high level resistance to antiretroviral drugs. T215D revertant mutation was transmitted in a large cluster comprising 25 individuals. The impact of epidemiological networks on TDR frequency may explain its persistence in newly diagnosed individuals. The knowledge of the populations involved in TC would facilitate the design of prevention programs and public health interventions.
Collapse
Affiliation(s)
- Yolanda Vega
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Delgado
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aurora Fernández-García
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Maria Teresa Cuevas
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail:
| | - Michael M. Thomson
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Vanessa Montero
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Monica Sánchez
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana Maria Sánchez
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Lucia Pérez-Álvarez
- Unidad de Biología y Variabilidad de VIH, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | |
Collapse
|
37
|
Fernández-García A, Romero C, Garzón N. "Dry Lake" technique for the treatment of hypertrophic bleb following XEN(®) Gel Stent placement. ACTA ACUST UNITED AC 2015; 90:536-8. [PMID: 26008922 DOI: 10.1016/j.oftal.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/07/2015] [Indexed: 10/23/2022]
Abstract
CASE REPORT The case of a patient with previous uncomplicated XEN(®) drainage glaucoma surgery is described, who presented with hypertrophic bleb and mechanical ectropion. Treatment consisted of the «Dry Lake» procedure to drain the hypertrophic bleb following blockage with viscoelastic of the ab-interno stent and bleb sealing with a tissue adhesive. DISCUSSION Proposals for the management of this type of bleb include therapeutic strategies, sutures or even autologous blood. The use of Tissucol(®), already described in glaucoma surgery, may be appropriate to treat this complication of XEN(®) placement.
Collapse
Affiliation(s)
| | - C Romero
- Instituto de Oftalmología Avanzada, Madrid, España
| | - N Garzón
- Instituto de Oftalmología Avanzada, Madrid, España
| |
Collapse
|
38
|
Sutter F, Fernández-García A, Heller P, Anderson K, Wilson G, Schmücker M, Marvig P. Durability Testing of Silvered-Glass Mirrors. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.egypro.2015.03.110] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Shcherbakova NS, Shalamova LA, Delgado E, Fernández-García A, Vega Y, Karpenko LI, Ilyichev AA, Sokolov YV, Shcherbakov DN, Pérez-Álvarez L, Thomson MM. Short communication: Molecular epidemiology, phylogeny, and phylodynamics of CRF63_02A1, a recently originated HIV-1 circulating recombinant form spreading in Siberia. AIDS Res Hum Retroviruses 2014; 30:912-9. [PMID: 25050828 DOI: 10.1089/aid.2014.0075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The HIV-1 epidemic in Russia is dominated by the former Soviet Union subtype A (A(FSU)) variant, but other genetic forms are circulating in the country. One is the recently described CRF63_02A1, derived from recombination between a CRF02_AG variant circulating in Central Asia and A(FSU), which has spread in the Novosibirsk region, Siberia. Here we phylogenetically analyze pol and env segments from 24 HIV-1 samples from the Novosibirsk region collected in 2013, with characterization of three new near full-length genome CRF63_02A1 sequences, and estimate the time of the most recent common ancestor (tMRCA) and the demographic growth of CRF63_02A1 using a Bayesian method. The analyses revealed that CRF63_02A1 is highly predominant in the Novosibirsk region (81.2% in pol sequences) and is transmitted both among injecting drug users and by heterosexual contact. Similarity searches with database sequences combined with phylogenetic analyses show that CRF63_02A1 is circulating in East Kazakhstan and the Eastern area of Russia bordering China. The analyses of near full-length genome sequences show that its mosaic structure is more complex than reported, with 18 breakpoints. The tMRCA of CRF63_02A1 was estimated around 2006, with exponential growth in 2008-2009 and subsequent stabilization. These results provide new insights into the molecular epidemiology, phylogeny, and phylodynamics of CRF63_02A1.
Collapse
Affiliation(s)
- Nadezhda S. Shcherbakova
- Department of Bioengineering, State Research Center of Virology and Biotechnology “Vector,” Koltsovo, Novosibirsk, Russia
| | - Lyudmila A. Shalamova
- Department of Zoonotic Infections and Influenza, State Research Center of Virology and Biotechnology “Vector,” Koltsovo, Novosibirsk, Russia
| | - Elena Delgado
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aurora Fernández-García
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Yolanda Vega
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Larissa I. Karpenko
- Laboratory of Recombinant Vaccine, State Research Center of Virology and Biotechnology “Vector,” Koltsovo, Novosibirsk, Russia
| | - Alexander A. Ilyichev
- Department of Bioengineering, State Research Center of Virology and Biotechnology “Vector,” Koltsovo, Novosibirsk, Russia
| | - Yuri V. Sokolov
- Center for Prevention and Control of AIDS and Infectious Diseases, Koltsovo, Novosibirsk, Russia
| | | | - Lucía Pérez-Álvarez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M. Thomson
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| |
Collapse
|
40
|
Pérez-Álvarez L, Delgado E, Vega Y, Montero V, Cuevas T, Fernández-García A, García-Riart B, Pérez-Castro S, Rodríguez-Real R, López-Álvarez MJ, Fernández-Rodríguez R, Lezaun MJ, Ordóñez P, Ramos C, Bereciartua E, Calleja S, Sánchez-García AM, Thomson MM. Predominance of CXCR4 tropism in HIV-1 CRF14_BG strains from newly diagnosed infections. J Antimicrob Chemother 2013; 69:246-53. [PMID: 23900735 DOI: 10.1093/jac/dkt305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES R5-tropic viruses are associated with HIV-1 transmission and predominate during the early stages of infection. X4-tropic populations have been detected in ~50% of patients with late-stage disease infected with subtype B viruses. In this study, we compared the frequency of X4 tropism in individuals infected with HIV-1 CRF14_BG viruses, which have a V3 loop of subtype B, with a control group of individuals infected with subtype B viruses. METHODS Sixty-three individuals infected with HIV-1 CRF14_BG (n = 31) or subtype B (n = 32) were studied. Similar proportions of newly diagnosed and chronically infected individuals were included in the subtype B and CRF14_BG groups. V3 sequences were obtained and coreceptor tropism was predicted using the Geno2pheno[coreceptor] algorithm. V3 net charge and 11/25 rules were also used for coreceptor prediction. RESULTS Overall, X4 tropism was more frequent among individuals infected with CRF14_BG viruses (87.1%) than subtype B viruses (34.3%), a difference that was statistically highly significant (P = 0.00001). Importantly, the frequencies among newly diagnosed individuals were 90% and 13.3%, respectively (P = 0.0007). Characteristic amino acids in the V3 loop (T13, M14, V19 and W20) were identified at higher frequencies in CRF14_BG viruses (54%) than subtype B viruses (0%; P < 0.000001). CONCLUSIONS CRF14_BG is the genetic form with the highest proportion of X4-tropic viruses reported to date in newly diagnosed and chronic infections. This suggests high pathogenicity for CRF14_BG viruses, potentially leading to rapid disease progression. CCR5 antagonists will be ineffective in most CRF14_BG-infected patients, even at early stages of infection.
Collapse
Affiliation(s)
- Lucía Pérez-Álvarez
- HIV Biology and Variability Unit, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Vega Y, Delgado E, Carrera C, Nebreda P, Fernández-García A, Cuevas MT, Pérez-Álvarez L, Thomson MM. Identification of new and unusual rev and nef transcripts expressed by an HIV type 1 primary isolate. AIDS Res Hum Retroviruses 2013; 29:1075-8. [PMID: 23540799 DOI: 10.1089/aid.2013.0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We analyzed RNA splice site usage in three HIV-1 subtype B primary isolates through reverse transcriptase polymerase chain reaction (RT-PCR) amplification of spliced RNAs using a fluorescently labeled primer, with computerized size determination and quantification of PCR products, which were also identified by clone sequencing. In one isolate, P2149-3, unusual and unreported spliced transcripts were detected. This isolate preferentially used for rev RNA generation a 3' splice site (3'ss) located five nucleotides upstream of A4a, previously identified only in a T cell line-adapted virus and in a group O isolate, and designated A4d. P2149-3 also used an unreported 3'ss for rev RNA generation, designated A4h, located 20 nucleotides upstream of 3'ss A4c. Additionally, unusual nef RNAs using 3'ss A5a and A7a and with exon composition 1.3.7 were identified. The identification of several unusual and unreported spliced transcripts in an HIV-1 primary isolate suggests a greater diversity of splice site usage in HIV-1 than previously appreciated.
Collapse
Affiliation(s)
- Yolanda Vega
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Cristina Carrera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Paloma Nebreda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - María Teresa Cuevas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M. Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| |
Collapse
|
42
|
Díez-Fuertes F, Delgado E, Vega Y, Fernández-García A, Cuevas MT, Pinilla M, García V, Pérez-Álvarez L, Thomson MM. Improvement of HIV-1 coreceptor tropism prediction by employing selected nucleotide positions of the env gene in a Bayesian network classifier. J Antimicrob Chemother 2013; 68:1471-85. [DOI: 10.1093/jac/dkt077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
|
43
|
Fernández-García A, Revilla A, Vázquez-de Parga E, Vinogradova A, Rakhmanova A, Karamov E, Carrera C, Delgado E, Pérez-Álvarez L, Nájera R, Osmanov S, Thomson MM. The analysis of near full-length genome sequences of HIV type 1 subtype A viruses from Russia supports the monophyly of major intrasubtype clusters. AIDS Res Hum Retroviruses 2012; 28:1340-3. [PMID: 22251084 DOI: 10.1089/aid.2011.0393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The HIV-1 epidemic in Russia has been insufficiently studied, with only 11 complete genome sequences from this country currently available, only three of which are of the locally predominant genetic form, the former Soviet Union (FSU) subtype A variant (A(FSU)). Here we analyze 10 newly derived A(FSU) near full-length genome sequences from Russia. Samples were selected based on phylogenetic clustering in protease-reverse transcriptase in two of the major A(FSU) clusters, V77I(PR) (n=6), widely circulating in Russia and other FSU countries, and A(SP1) (n=4), predominant in St. Petersburg. The phylogenetic analysis shows that the V77I(PR) genomes group in a monophyletic cluster together with 10 previously obtained A(FSU) genome sequences from Uzbekistan, Kazakhstan, Russia, and Cyprus, all bearing the V77I substitution in protease. Similarly, the four A(SP1) genomes group in a monophyletic cluster. These results therefore show that the monophyly of V77I(PR) and A(SP1) A(FSU) clusters is supported in near complete genomes.
Collapse
Affiliation(s)
| | - Ana Revilla
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Vázquez-de Parga
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Aza Rakhmanova
- Botkin's Infectious Diseases Hospital, St. Petersburg, Russia
| | | | - Cristina Carrera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Rafael Nájera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Michael M. Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| |
Collapse
|
44
|
Matesanz R, Coll E, Domínguez-Gil B, de la Rosa G, Marazuela R, Arráez V, Elorrieta P, Fernández-García A, Fernández-Renedo C, Galán J, Gómez-Marinero P, Martín-Delagebasala C, Martín-Jiménez S, Masnou N, Salamero P, Sánchez-Ibáñez J, Serna E, Martínez-Soba F, Pastor-Rodríguez A, Bouzas E, Castro P. Benchmarking in the process of donation after brain death: a methodology to identify best performer hospitals. Am J Transplant 2012; 12:2498-506. [PMID: 22682056 DOI: 10.1111/j.1600-6143.2012.04128.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003-2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.
Collapse
Affiliation(s)
- R Matesanz
- Organización Nacional de Trasplantes, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Delgado E, Carrera C, Nebreda P, Fernández-García A, Pinilla M, García V, Pérez-Álvarez L, Thomson MM. Identification of new splice sites used for generation of rev transcripts in human immunodeficiency virus type 1 subtype C primary isolates. PLoS One 2012; 7:e30574. [PMID: 22363449 PMCID: PMC3281843 DOI: 10.1371/journal.pone.0030574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 12/21/2011] [Indexed: 12/16/2022] Open
Abstract
The HIV-1 primary transcript undergoes a complex splicing process by which more than 40 different spliced RNAs are generated. One of the factors contributing to HIV-1 splicing complexity is the multiplicity of 3′ splice sites (3'ss) used for generation of rev RNAs, with two 3'ss, A4a and A4b, being most commonly used, a third site, A4c, used less frequently, and two additional sites, A4d and A4e, reported in only two and one isolates, respectively. HIV-1 splicing has been analyzed mostly in subtype B isolates, and data on other group M clades are lacking. Here we examine splice site usage in three primary isolates of subtype C, the most prevalent clade in the HIV-1 pandemic, by using an in vitro infection assay of peripheral blood mononuclear cells. Viral spliced RNAs were identified by RT-PCR amplification using a fluorescently-labeled primer and software analyses and by cloning and sequencing the amplified products. The results revealed that splice site usage for generation of rev transcripts in subtype C differs from that reported for subtype B, with most rev RNAs using two previously unreported 3'ss, one located 7 nucleotides upstream of 3'ss A4a, designated A4f, preferentially used by two isolates, and another located 14 nucleotides upstream of 3'ss A4c, designated A4g, preferentially used by the third isolate. A new 5′ splice site, designated D2a, was also identified in one virus. Usage of the newly identified splice sites is consistent with sequence features commonly found in subtype C viruses. These results show that splice site usage may differ between HIV-1 subtypes.
Collapse
Affiliation(s)
- Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Cristina Carrera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Paloma Nebreda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Milagros Pinilla
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Valentina García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M. Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- * E-mail:
| |
Collapse
|
46
|
Delgado E, Fernández-García A, Vega Y, Cuevas T, Pinilla M, García V, Sánchez M, González M, Sánchez AM, Thomson MM, Pérez-Álvarez L. Evaluation of genotypic tropism prediction tests compared with in vitro co-receptor usage in HIV-1 primary isolates of diverse subtypes. J Antimicrob Chemother 2011; 67:25-31. [PMID: 22010208 DOI: 10.1093/jac/dkr438] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES To evaluate the sensitivity and specificity of genotypic methods for predicting the co-receptor usage of subtypes B and non-B HIV-1 primary isolates, using as gold standard the infectivity of each primary isolate in GHOST cells stably expressing HIV-1 co-receptors. METHODS Primary isolates were obtained by co-culturing either patient's peripheral blood mononuclear cells (PBMCs) or ultracentrifuged plasma with donor-activated PBMCs. In vitro co-receptor usage was determined by infecting GHOST cells. Tropism prediction, based on V3 sequences, was determined with simple rules and bioinformatic tools (Geno2pheno[coreceptor] and WebPSSM). RESULTS This study includes 102 HIV-1 primary isolates; 23 (22.5%) subtype B and 79 (77.5%) non-B genetic forms. V3 sequences were classified into six subtypes (A-G), although 32 (31.4%) were circulating recombinant forms and 21 (20.6%) were unique recombinant forms. Sixty-nine isolates were R5, 27 R5X4 and 6 X4. The highest levels of sensitivity and specificity for the detection of X4 strains among V3 sequences, between 91% and 100%, were obtained by using PSSM(x4r5), PSSM(si/nsi) and the 11/25 rule for sequences of subtypes A, B and G, but not for subtype F. Establishing the recommended cut-off for clinical settings of a 10% false positive rate for Geno2pheno, we obtained 93% specificity and 97% sensitivity. CONCLUSIONS Comparing genotypic assays for HIV-1 co-receptor use with a cell-culture phenotypic assay could provide more reliable results of sensitivity and specificity for the detection of X4 strains than comparing them with recombinant assays, considered as gold standard. In general, except for subtype F isolates, there is a good correlation for tropism prediction.
Collapse
Affiliation(s)
- Elena Delgado
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Thomson MM, Fernández-García A. Phylogenetic structure in African HIV-1 subtype C revealed by selective sequential pruning. Virology 2011; 415:30-8. [PMID: 21507449 DOI: 10.1016/j.virol.2011.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/11/2011] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
Subtype C is the most prevalent clade in the HIV-1 pandemic. Previous studies suggested that African HIV-1 subtype C lacks a well-defined phylogenetic structure. Here we show that, by sequential pruning of ambiguously positioned taxa, a well-defined intrasubtype C phylogenetic structure becomes apparent, with 52% African HIV-1 subtype C isolates analyzed in envelope sequences branching within 11 clusters, also supported in a tree of full-length genomes, and all with geographical associations. Among 46 viruses recently transmitted in South Africa, 70% branched within 7 clusters (41% in the largest one) and 15% additional isolates were intercluster recombinants. Choice of the outgroup sequence and inclusion of intrasubtype recombinant viruses in the analyses could greatly affect support of clusters. The identification of clusters comprising a large proportion of African HIV-1 subtype C viruses may have implications for the design of vaccines intended for use in areas where subtype C is prevalent.
Collapse
Affiliation(s)
- Michael M Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo Km. 2, Majadahonda, Madrid, Spain.
| | | |
Collapse
|
48
|
Cuevas M, Fernández-García A, Pinilla M, García-Álvarez V, Thomson M, Delgado E, González-Galeano M, Miralles C, Serrano-Bengoechea E, Ojea de Castro R, López-Álvarez M, Lezáun M, Sánchez-García A, Sánchez-Martínez M, Muñoz-Nieto M, Pérez-Álvarez L. Short communication: Biological and genetic characterization of HIV type 1 subtype B and nonsubtype B transmitted viruses: usefulness for vaccine candidate assessment. AIDS Res Hum Retroviruses 2010; 26:1019-25. [PMID: 20707647 DOI: 10.1089/aid.2010.0018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Due to the extraordinary degree of genetic diversity of HIV-1 and the structural complexity of its envelope glycoproteins, designing an effective vaccine is difficult, requiring the development of viral reagents to assess vaccine-elicited neutralizing antibodies. The aim of this study was to improve on our previously developed panel of HIV-1 strains of different genetic forms, focusing on strains from acute and recently acquired infections as the most representative of the transmitted viruses. HIV-1 primary isolates were expanded in peripheral blood mononuclear cells. Viral stocks of 40 ml each were produced. Syncytium-inducing (SI) phenotype, coreceptor use, and TCID(50)/ml were determined. Near full-length HIV-1 genomes were amplified by RT-nested PCR in four overlapping segments. Phylogenetic analyses were performed with neighbor-joining trees and bootscanning. Forty-four HIV-1 strains were included in the panel. Twenty-four (54.1%) strains were from early infections (16 acute and 8 recent); of them, 21 (87%) were sexually transmitted. NSI/R5 phenotype was detected in 37 (84.1%) viruses and SI/R5,X4 in another 7 (15.9%). TCID(50)/ml ranged between 10(4) and 10(6.6). Twelve different genetic forms constituted this panel: subtypes A1, B, C, F1, and G; circulating recombinant forms CRF02_AG, CRF14_BG, and CRF24_BG; and unique recombinant forms CRF02_AG/A3, BF1, CRF12_BF/B, and DF1G. In conclusion, in this study, we report the development of a comprehensive and well-characterized panel of HIV-1 isolates for assessing neutralization in HIV vaccine research. This panel is available for distribution through the Programme EVA Centre for AIDS Reagents, National Institute for Biological Standard and Control (NIBSC).
Collapse
Affiliation(s)
- M.T. Cuevas
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - A. Fernández-García
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Pinilla
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - V. García-Álvarez
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Thomson
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - E. Delgado
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. González-Galeano
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - C. Miralles
- Complejo Hospitalario Universitario Xeral Cies de Vigo, Pontevedra, Galicia, Spain
| | | | | | | | - M.J. Lezáun
- Hospital Txagorritxu, Vitoria, Álava, País Vasco, Spain
| | - A.M. Sánchez-García
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Sánchez-Martínez
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M. Muñoz-Nieto
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - L. Pérez-Álvarez
- HIV Biology and Variability Department, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| |
Collapse
|
49
|
Fernández-García A, Alvarez-García G, Risco-Castillo V, Aguado-Martínez A, Marcén JM, Rojo-Montejo S, Castillo JA, Ortega-Mora LM. Development and use of an indirect ELISA in an outbreak of bovine besnoitiosis in Spain. Vet Rec 2010; 166:818-22. [PMID: 20581359 DOI: 10.1136/vr.b4874] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
An indirect ELISA based on a soluble extract of Besnoitia besnoiti tachyzoites was developed and standardised. A set of positive and negative reference bovine sera were characterised using an immunofluorescence antibody test and Western blot. A cut-off with a relative index per cent of 8.1 was determined for equal sensitivity and specificity (100 per cent) by two-graph receiver operating characteristic analysis. Cross-reactions with other closely related Apicomplexan parasites were discarded. The standardised ELISA was then used during an outbreak of bovine besnoitiosis in a mountainous area of central Spain. The outbreak occurred in nine herds, and 358 animals that shared grazing lands during the summer season were affected. Clinical examination and blood sampling were carried out for all animals, and skin biopsies were obtained from animals with skin lesions. The confirmatory diagnosis was carried out by means of the indirect ELISA, together with the identification of tissue cysts by microscopy. Most of the animals were seropositive (90.5 per cent), but only 43 per cent of seropositive cattle developed clinical signs compatible with besnoitiosis. Additionally, a significant increase in seroprevalence and clinical signs was found to be associated with the increasing age of the animals, suggesting rapid horizontal transmission of the disease.
Collapse
Affiliation(s)
- A Fernández-García
- SALUVET Research Group, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, Ciudad Universitaria s/n, 28040 Madrid, Spain
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Fernández-García A, Pérez-Álvarez L, Cuevas MT, Delgado E, Muñoz-Nieto M, Cilla G, Iribarren JA, Pinilla M, Ocampo A, Miralles C, Pérez-Castro S, González-Galeano M, de Castro RO, Trigo M, García V, Sánchez AM, Thomson MM. Identification of a new HIV type 1 circulating BF intersubtype recombinant form (CRF47_BF) in Spain. AIDS Res Hum Retroviruses 2010; 26:827-32. [PMID: 20618102 DOI: 10.1089/aid.2009.0311] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report the identification of a new HIV-1 circulating recombinant form (CRF47_BF) derived from subtypes B and F. It was initially identified in protease-reverse transcriptase sequences from nine individuals from three separate regions of Spain who acquired HIV-1 infection via sexual contact. All nine sequences formed a strongly supported phylogenetic cluster, branching apart from all known CRFs, and in bootscan analyses were BF mosaics with two coincident breakpoints. Two epidemiologically unlinked viruses were sequenced in near full-length genomes, which exhibited identical mosaic structures, with 16 intersubtype breakpoints in a genome predominantly of subtype B. Subtype F segments of the new CRF failed to cluster with any of the near full-length genome subtype F sequences available in public databases. Recent dates of HIV-1 diagnoses and short genetic distances suggest a recent origin of this CRF. This is the tenth reported CRF_BF, the first apparently having originated outside of South America.
Collapse
Affiliation(s)
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María Teresa Cuevas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Mercedes Muñoz-Nieto
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Gustavo Cilla
- Complejo Hospitalario Donostia, San Sebastián, Guipúzcoa, Spain
| | | | - Milagros Pinilla
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Antonio Ocampo
- Complejo Hospitalario Universitario Xeral Cies, Vigo, Pontevedra, Spain
| | - Celia Miralles
- Complejo Hospitalario Universitario Xeral Cies, Vigo, Pontevedra, Spain
| | | | - María González-Galeano
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Matilde Trigo
- Complejo Hospitalario Provincial de Pontevedra, Pontevedra, Spain
| | - Valentina García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana M. Sánchez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M. Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| |
Collapse
|