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Ezpeleta G, Navascués A, Viguria N, Herranz-Aguirre M, Juan Belloc SE, Gimeno Ballester J, Muruzábal JC, García-Cenoz M, Trobajo-Sanmartín C, Echeverria A, Martínez-Baz I, Vera-Punzano N, Casado I, López-Mendoza H, Ezpeleta C, Castilla J. Effectiveness of Nirsevimab Immunoprophylaxis Administered at Birth to Prevent Infant Hospitalisation for Respiratory Syncytial Virus Infection: A Population-Based Cohort Study. Vaccines (Basel) 2024; 12:383. [PMID: 38675765 PMCID: PMC11054679 DOI: 10.3390/vaccines12040383] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Respiratory syncytial virus (RSV) infection is a frequent cause of hospitalisation in the first few months of life; however, this risk rapidly decreases with age. Nirsevimab immunoprophylaxis was approved in the European Union for the prevention of RSV-associated lower respiratory tract disease in infants during their first RSV season. We evaluated the effectiveness of nirsevimab in preventing hospitalisations for confirmed RSV infection and the impact of a strategy of immunisation at birth. A population-based cohort study was performed in Navarre, Spain, where nirsevimab was offered at birth to all children born from October to December 2023. Cox regression was used to estimate the hazard ratio of hospitalisation for PCR-confirmed RSV infection between infants who received and did not receive nirsevimab. Of 1177 infants studied, 1083 (92.0%) received nirsevimab. The risk of hospitalisation for RSV was 8.5% (8/94) among non-immunised infants versus 0.7% (8/1083) in those that were immunised. The estimated effectiveness of nirsevimab was 88.7% (95% confidence interval, 69.6-95.8). Immunisation at birth of infants born between October and December 2023 prevented one hospitalisation for every 15.3 immunised infants. Immunisation of children born from September to January might prevent 77.5% of preventable hospitalisations for RSV in infants born in 2023-2024. These results support the recommendation of nirsevimab immunisation at birth to children born during the RSV epidemic or in the months immediately before to prevent severe RSV infections and alleviate the overload of paediatric hospital resources.
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Affiliation(s)
- Guillermo Ezpeleta
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
| | - Ana Navascués
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
| | - Natividad Viguria
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- Paediatrics Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Mercedes Herranz-Aguirre
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- Paediatrics Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | | | | | - Juan Carlos Muruzábal
- Gynecology and Obstetrics Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Manuel García-Cenoz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 31003 Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 31003 Pamplona, Spain
| | - Aitziber Echeverria
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 31003 Pamplona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 31003 Pamplona, Spain
| | - Noelia Vera-Punzano
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 31003 Pamplona, Spain
| | - Héctor López-Mendoza
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
| | - Carmen Ezpeleta
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (G.E.); (I.M.-B.); (H.L.-M.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain (M.H.-A.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 31003 Pamplona, Spain
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De Waele A, Hendrickx G, Valckx S, Domínguez À, Toledo D, Castilla J, Tuells J, Van Damme P. The Vaccine Training Barometer: Assessing healthcare providers' confidence to answer vaccine-related questions and their training needs. Vaccine 2024; 42:2421-2428. [PMID: 38458873 DOI: 10.1016/j.vaccine.2024.02.078] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
Healthcare providers (HCP) are seen by the public as the most trustworthy source of information about vaccination. While HCPs could be a valuable partner to increase vaccine confidence in general, it is not clear whether they feel confident themselves to address questions concerning vaccination. In the context of the EU Joint Action on Vaccination (EU-JAV), the Vaccine Training Barometer, an online survey tool, was developed to assess how frequently HCPs receive questions about vaccination, how confident they feel to answer these questions, and to what extent they are willing to follow extra training. After a pilot test in Flanders, Belgium, the Barometer was launched and completed by 833 HCPs in Flanders and 291 HCPs in the Spanish regions of Catalonia, Navarre and Valencian Community from November 2020 until January 2021, during the COVID-19 pandemic, just before and during the start of the first COVID-19 vaccination campaigns. In both countries, HCPs frequently received questions about vaccination (mostly on a daily or weekly basis), and about two thirds of them indicated that the frequency of questions had increased during the three months prior to completing the survey. Most questions were about the side effects and safety of vaccines. In both countries, a considerable proportion of HCPs did not feel confident to answer vaccine-related questions (31.5% felt confident in Flanders, 21.6% in Spain). A large proportion of HCPs received questions in the last three months before the survey that they could not answer (52.4% of respondents in Flemish sample, 41.5% in Spanish sample). Only 11.4% (Flanders) and 11.3% (Spain) of the respondents felt they gained sufficient knowledge through their standard education to be able to answer questions about vaccination. Almost all respondents were willing to follow extra training on vaccination (Flanders: 95.4%, Spain: 96.6%). The Vaccine Training Barometer is thus a useful tool to monitor HCPs' confidence to answer questions about vaccination and to capture their training needs.
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Affiliation(s)
- Aurélie De Waele
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium; Departement of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobsstraat 2, 2000 Antwerp, Belgium.
| | - Greet Hendrickx
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Sara Valckx
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
| | - Àngela Domínguez
- Universitat de Barcelona, Department of Medicine, C/ de Casanova, 143, 08036 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Diana Toledo
- Universitat de Barcelona, Department of Medicine, C/ de Casanova, 143, 08036 Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain.
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Instituto de Salud Pública de Navarra (IdiSNA), C. de Irunlarrea, 3, 31008 Pamplona, Navarra, Spain.
| | - José Tuells
- Edificio Ciencias Sociales, University of Alicante, Carr. de San Vicente del Raspeig, 03690 San Vicente del Raspeig, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Avda Pintor Baeza, 12, 03010 Alicante, Spain.
| | - Pierre Van Damme
- Centre for Evaluation of Vaccination, University of Antwerp, Drie Eikenstraat 663, 2650 Edegem, Belgium.
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Monge S, Humphreys J, Nicolay N, Braeye T, Van Evercooren I, Holm Hansen C, Emborg H, Sacco C, Mateo‐Urdiales A, Castilla J, Martínez‐Baz I, de Gier B, Hahné S, Meijerink H, Kristoffersen A, Machado A, Soares P, Nardone A, Bacci S, Kissling E, Nunes B. Effectiveness of XBB.1.5 Monovalent COVID-19 Vaccines During a Period of XBB.1.5 Dominance in EU/EEA Countries, October to November 2023: A VEBIS-EHR Network Study. Influenza Other Respir Viruses 2024; 18:e13292. [PMID: 38654485 PMCID: PMC11040092 DOI: 10.1111/irv.13292] [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: 03/15/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Using a common protocol across seven countries in the European Union/European Economic Area, we estimated XBB.1.5 monovalent vaccine effectiveness (VE) against COVID-19 hospitalisation and death in booster-eligible ≥ 65-year-olds, during October-November 2023. We linked electronic records to construct retrospective cohorts and used Cox models to estimate adjusted hazard ratios and derive VE. VE for COVID-19 hospitalisation and death was, respectively, 67% (95%CI: 58-74) and 67% (95%CI: 42-81) in 65- to 79-year-olds and 66% (95%CI: 57-73) and 72% (95%CI: 51-85) in ≥ 80-year-olds. Results indicate that periodic vaccination of individuals ≥ 65 years has an ongoing benefit and support current vaccination strategies in the EU/EEA.
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Affiliation(s)
- Susana Monge
- Department of Communicable Diseases, National Centre of EpidemiologyInstitute of Health Carlos IIIMadridSpain
- CIBER on Infectious DiseasesMadridSpain
| | | | - Nathalie Nicolay
- Vaccine Preventable Diseases and ImmunisationEuropean Centre for Disease Prevention and Control (ECDC)SolnaSweden
| | | | | | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology and PreventionStatens Serum InstitutCopenhagenDenmark
| | - Hanne‐Dorthe Emborg
- Department of Infectious Disease Epidemiology and PreventionStatens Serum InstitutCopenhagenDenmark
| | - Chiara Sacco
- Infectious Diseases DepartmentIstituto Superiore di SanitàRomeItaly
- European Programme on Intervention Epidemiology Training (EPIET)European Centre for Disease Prevention and ControlStockholmSweden
| | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNAPamplonaSpain
- CIBER on Epidemiology and Public HealthMadridSpain
| | - Iván Martínez‐Baz
- Instituto de Salud Pública de Navarra – IdiSNAPamplonaSpain
- CIBER on Epidemiology and Public HealthMadridSpain
| | - Brechje de Gier
- Center for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Susan Hahné
- Center for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | - Ausenda Machado
- Departamento de EpidemiologiaInstituto Nacional de Saúde Doutor Ricardo JorgeLisboaPortugal
| | - Patricia Soares
- Departamento de EpidemiologiaInstituto Nacional de Saúde Doutor Ricardo JorgeLisboaPortugal
| | | | - Sabrina Bacci
- Vaccine Preventable Diseases and ImmunisationEuropean Centre for Disease Prevention and Control (ECDC)SolnaSweden
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Trobajo-Sanmartín C, Navascués A, Fernández-Huerta M, Martínez-Baz I, Casado I, Ezpeleta C, Castilla J. Prevalence of Respiratory Viral Infections in Deceased Persons during the COVID-19 Pandemic Season 2021-2022: A Population-Based Observational Study. Viruses 2024; 16:533. [PMID: 38675876 PMCID: PMC11053769 DOI: 10.3390/v16040533] [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: 03/05/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Although the omicron variant of SARS-CoV-2 circulated intensely during the 2021-2022 season, many patients with severe acute respiratory disease tested negative for COVID-19. The aim of this study was to assess the presence of different respiratory viruses in deceased persons. The proportion of deceased persons with respiratory viral infections in the 2021-2022 season in Navarre, Spain, was estimated considering all deaths caused by confirmed COVID-19 according to the epidemiological surveillance and the results of multiplex PCR tests for respiratory viruses performed in a sample of deceased persons with a cause of death other than COVID-19. Of 3578 deaths, 324 (9.1%) were initially reported as caused by pre-mortem confirmed COVID-19. A sample of 242 persons who died by causes other than COVID-19 were tested post-mortem; 64 (26.4%) of them were positive for any respiratory virus: 11.2% for SARS-CoV-2, 5.8% for rhinovirus, 3.7% for human coronavirus, 2.5% for metapneumovirus, 1.7% for respiratory syncytial virus, 1.7% for parainfluenza, 1.2% for influenza, and less than 1% each for adenovirus and bocavirus. Combining both approaches, we estimated that 34.4% of all deceased persons during the study period had a respiratory viral infection and 19.2% had SARS-CoV-2. Only 33.3% (9/27) of SARS-CoV-2 and 5.0% (2/40) of other viruses detected post-mortem had previously been confirmed pre-mortem. In a period with very intense circulation of SARS-CoV-2 during the pandemic, other respiratory viruses were also frequently present in deceased persons. Some SARS-CoV-2 infections and most other viral infections were not diagnosed pre-mortem. Several respiratory viruses may contribute to excess mortality in winter.
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Affiliation(s)
- Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
| | - Ana Navascués
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Miguel Fernández-Huerta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
| | - Carmen Ezpeleta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain (I.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain; (A.N.); (M.F.-H.); (C.E.)
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Bullón-Vela V, Toledo D, Vera-Punzano N, Godoy P, García Cenoz M, Pardos-Plaza J, Castilla J, Domínguez A, Martínez-Baz I. [Level of knowledge, attitudes and the use of preventive measures among household contacts of COVID-19 cases after the acute phase of the pandemic]. An Sist Sanit Navar 2024; 47:e1070. [PMID: 38501156 PMCID: PMC11016338 DOI: 10.23938/assn.1070] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/04/2024] [Accepted: 01/31/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Assessment of the level of knowledge and attitudes regarding COVID-19 and preventive measures in household contacts of COVID-19 cases after the acute phase of the pandemic. METHODS Survey among household contacts of COVID-19 cases conducted in healthcare centers in Navarre (1) and Catalonia (8) between May 2022 and July 2023. The frequency of use of preventive measures and the knowledge and attitudes towards COVID-19 were assessed through 12 items. RESULTS 215 contacts participated who correctly used the preventive measures (>85%), except for facemasks (35.8%) and interpersonal distance (47%); >85% showed adequate knowledge (5/6 items) and >80% had a positive attitude (3/6 items). Moreover, 54.7% considered that COVID-19 negatively affected their life and 54.1% that it is better to develop immunity by getting infected than by vaccination. CONCLUSIONS Household contacts show a correct level of knowledge and positive attitude towards the disease and its preventive measures.
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Harewood R, Rothwell JA, Bešević J, Viallon V, Achaintre D, Gicquiau A, Rinaldi S, Wedekind R, Prehn C, Adamski J, Schmidt JA, Jacobs I, Tjønneland A, Olsen A, Severi G, Kaaks R, Katzke V, Schulze MB, Prada M, Masala G, Agnoli C, Panico S, Sacerdote C, Jakszyn PG, Sánchez MJ, Castilla J, Chirlaque MD, Atxega AA, van Guelpen B, Heath AK, Papier K, Tong TYN, Summers SA, Playdon M, Cross AJ, Keski-Rahkonen P, Chajès V, Murphy N, Gunter MJ. Association between pre-diagnostic circulating lipid metabolites and colorectal cancer risk: a nested case-control study in the European Prospective Investigation into Cancer and Nutrition (EPIC). EBioMedicine 2024; 101:105024. [PMID: 38412638 PMCID: PMC10907191 DOI: 10.1016/j.ebiom.2024.105024] [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: 09/29/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Altered lipid metabolism is a hallmark of cancer development. However, the role of specific lipid metabolites in colorectal cancer development is uncertain. METHODS In a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined associations between pre-diagnostic circulating concentrations of 97 lipid metabolites (acylcarnitines, glycerophospholipids and sphingolipids) and colorectal cancer risk. Circulating lipids were measured using targeted mass spectrometry in 1591 incident colorectal cancer cases (55% women) and 1591 matched controls. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between concentrations of individual lipid metabolites and metabolite patterns with colorectal cancer risk. FINDINGS Of the 97 assayed lipids, 24 were inversely associated (nominally p < 0.05) with colorectal cancer risk. Hydroxysphingomyelin (SM (OH)) C22:2 (ORper doubling 0.60, 95% CI 0.47-0.77) and acylakyl-phosphatidylcholine (PC ae) C34:3 (ORper doubling 0.71, 95% CI 0.59-0.87) remained associated after multiple comparisons correction. These associations were unaltered after excluding the first 5 years of follow-up after blood collection and were consistent according to sex, age at diagnosis, BMI, and colorectal subsite. Two lipid patterns, one including 26 phosphatidylcholines and all sphingolipids, and another 30 phosphatidylcholines, were weakly inversely associated with colorectal cancer. INTERPRETATION Elevated pre-diagnostic circulating levels of SM (OH) C22:2 and PC ae C34:3 and lipid patterns including phosphatidylcholines and sphingolipids were associated with lower colorectal cancer risk. This study may provide insight into potential links between specific lipids and colorectal cancer development. Additional prospective studies are needed to validate the observed associations. FUNDING World Cancer Research Fund (reference: 2013/1002); European Commission (FP7: BBMRI-LPC; reference: 313010).
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Affiliation(s)
- Rhea Harewood
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France.
| | - Joseph A Rothwell
- Centre for Epidemiology and Population Health (U1018), Exposome and Heredity Team, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, F-94805, Villejuif, France
| | - Jelena Bešević
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vivian Viallon
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - David Achaintre
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France; School of Plant Sciences and Food Security, Faculty of Biology, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Audrey Gicquiau
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Roland Wedekind
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Cornelia Prehn
- Metabolomics and Proteomics Core, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Jerzy Adamski
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, 8 Medical Drive, Singapore, 117597; Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany; Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Julie A Schmidt
- Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Inarie Jacobs
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark; The Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Gianluca Severi
- Centre for Epidemiology and Population Health (U1018), Exposome and Heredity Team, Faculté de Médecine, Université Paris-Saclay, UVSQ, INSERM, Gustave Roussy, F-94805, Villejuif, France; Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Marcela Prada
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia Federico Ii University, Naples, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Via Santena 7, 10126, Turin, Italy
| | - Paula Gabriela Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, 18012, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Jesús Castilla
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
| | - María-Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Amaia Aizpurua Atxega
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain; Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - Bethany van Guelpen
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Scott A Summers
- Department of Nutrition and Integrative Physiology and the Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, Utah, USA
| | - Mary Playdon
- Department of Nutrition and Integrative Physiology and the Diabetes and Metabolism Research Center, University of Utah, Salt Lake City, Utah, USA; Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Pekka Keski-Rahkonen
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Véronique Chajès
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Neil Murphy
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France
| | - Marc J Gunter
- International Agency for Research on Cancer (IARC), 25 Av. Tony Garnier, 69007, Lyon, France; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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7
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Lanièce Delaunay C, Martínez-Baz I, Sève N, Domegan L, Mazagatos C, Buda S, Meijer A, Kislaya I, Pascu C, Carnahan A, Oroszi B, Ilić M, Maurel M, Melo A, Sandonis Martín V, Trobajo-Sanmartín C, Enouf V, McKenna A, Pérez-Gimeno G, Goerlitz L, de Lange M, Rodrigues AP, Lazar M, Latorre-Margalef N, Túri G, Castilla J, Falchi A, Bennett C, Gallardo V, Dürrwald R, Eggink D, Guiomar R, Popescu R, Riess M, Horváth JK, Casado I, García MDC, Hooiveld M, Machado A, Bacci S, Kaczmarek M, Kissling E. COVID-19 vaccine effectiveness against symptomatic infection with SARS-CoV-2 BA.1/BA.2 lineages among adults and adolescents in a multicentre primary care study, Europe, December 2021 to June 2022. Euro Surveill 2024; 29:2300403. [PMID: 38551095 PMCID: PMC10979526 DOI: 10.2807/1560-7917.es.2024.29.13.2300403] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/14/2023] [Indexed: 04/01/2024] Open
Abstract
BackgroundScarce European data in early 2021 suggested lower vaccine effectiveness (VE) against SARS-CoV-2 Omicron lineages than previous variants.AimWe aimed to estimate primary series (PS) and first booster VE against symptomatic BA.1/BA.2 infection and investigate potential biases.MethodsThis European test-negative multicentre study tested primary care patients with acute respiratory symptoms for SARS-CoV-2 in the BA.1/BA.2-dominant period. We estimated PS and booster VE among adults and adolescents (PS only) for all products combined and for Comirnaty alone, by time since vaccination, age and chronic condition. We investigated potential bias due to correlation between COVID-19 and influenza vaccination and explored effect modification and confounding by prior SARS-CoV-2 infection.ResultsAmong adults, PS VE was 37% (95% CI: 24-47%) overall and 60% (95% CI: 44-72%), 43% (95% CI: 26-55%) and 29% (95% CI: 13-43%) < 90, 90-179 and ≥ 180 days post vaccination, respectively. Booster VE was 42% (95% CI: 32-51%) overall and 56% (95% CI: 47-64%), 22% (95% CI: 2-38%) and 3% (95% CI: -78% to 48%), respectively. Primary series VE was similar among adolescents. Restricting analyses to Comirnaty had little impact. Vaccine effectiveness was higher among older adults. There was no signal of bias due to correlation between COVID-19 and influenza vaccination. Confounding by previous infection was low, but sample size precluded definite assessment of effect modification.ConclusionPrimary series and booster VE against symptomatic infection with BA.1/BA.2 ranged from 37% to 42%, with similar waning post vaccination. Comprehensive data on previous SARS-CoV-2 infection would help disentangle vaccine- and infection-induced immunity.
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Affiliation(s)
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Noémie Sève
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Lisa Domegan
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Clara Mazagatos
- National Centre of Epidemiology, CIBERESP, Carlos III Health Institute, Madrid, Spain
| | - Silke Buda
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Irina Kislaya
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Catalina Pascu
- Cantacuzino National Military Medical Institute for Research and Development, Bucharest, Romania
| | | | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Maja Ilić
- Croatian Institute of Public Health (CIPH), Zagreb, Croatia
| | | | - Aryse Melo
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Vincent Enouf
- Institut Pasteur, Pasteur International Bioresources network (PIBnet), Plateforme de Microbiologie Mutualisée (P2M), Paris, France
- Institut Pasteur, Centre National de Référence Virus des Infections Respiratoires (CNR VIR), Paris, France
| | - Adele McKenna
- Health Protection Surveillance Centre, Dublin, Ireland
| | - Gloria Pérez-Gimeno
- National Centre of Epidemiology, CIBERESP, Carlos III Health Institute, Madrid, Spain
| | - Luise Goerlitz
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Marit de Lange
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Mihaela Lazar
- Cantacuzino National Military Medical Institute for Research and Development, Bucharest, Romania
| | | | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Charlene Bennett
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Virtudes Gallardo
- Dirección General de Salud Pública y Ordenación Farmacéutica, Junta de Andalucía, Sevilla, Spain
| | - Ralf Dürrwald
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Dirk Eggink
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | | | - Judit Krisztina Horváth
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mª Del Carmen García
- Subdirección de Epidemiología, Dirección General de Salud Pública, Servicio Extremeño de Salud, Mérida, Spain
| | | | - Ausenda Machado
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marlena Kaczmarek
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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8
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Bullón-Vela V, Toledo D, Echeverría A, Godoy P, Cenoz MG, Parrón I, Castilla J, Domínguez A, Martínez-Baz I. Absence of short-term changes in knowledge and attitudes among household contacts of COVID-19 cases during the post-acute phase of the pandemic in Catalonia and Navarre, Spain. Front Public Health 2024; 12:1306284. [PMID: 38487191 PMCID: PMC10937404 DOI: 10.3389/fpubh.2024.1306284] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Objectives To evaluate short-term changes in knowledge and attitude towards COVID-19 and preventive measures during the post-acute phase of the pandemic in Spain. Methods A survey was performed in Catalonia and Navarre between May-2022 and July-2023 in household contacts of COVID-19 cases. Knowledge and attitude were assessed at baseline and at three months, using a Likert scale. Responses were grouped according to correct or incorrect. Results At baseline, 172 subjects were contacted, 118 (69%) of which completed a follow-up interview three months later. Knowledge of correct hand-washing and mask protocols had maintained over time (-1.7%, p = 0.553 and - 2.5%, p = 0.473, respectively). Attitudes toward preventive measures was adequate in the first interview (86%), but attitudes regarding use of face masks decreased significantly (-9.1%, p = 0.048) over time in participants with higher risk of severe COVID-19. However, most short-term changes in knowledge and attitudes were not statistically significant. Conclusion Household contacts showed correct knowledge and attitude towards COVID-19 and its preventive measures, without significant changes in the short term despite a relaxation of government-mandated preventive measures. These results provide relevant information in case of a new health emergency due to respiratory viruses.
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Affiliation(s)
- Vanessa Bullón-Vela
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Diana Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | - Pere Godoy
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Medicina, Universitat de Lleida, Catalonia, Spain
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Catalonia, Spain
| | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ignasi Parrón
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Angela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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9
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Fontán-Vela M, Hernando V, Olmedo C, Coma E, Martínez M, Moreno-Perez D, Lorusso N, Vázquez Torres M, Barbas del Buey JF, Roig-Sena J, Pastor E, Galmés Truyols A, Artigues Serra F, Sancho Martínez RM, Latasa Zamalloa P, Pérez Martínez O, Vázquez Estepa A, García Rojas AJ, Barreno Estévez AI, Sánchez-Migallón Naranjo A, Pérez Martín JJ, Peces Jiménez P, Morales Romero R, Castilla J, García Cenoz M, Huerta Huerta M, Boone ALD, Macías Ortiz MJ, Álvarez Río V, Rodríguez Recio MJ, Merino Díaz M, Berradre Sáenz B, Villegas-Moreno MT, Limia A, Diaz A, Monge S. Effectiveness of Modified Vaccinia Ankara-Bavaria Nordic Vaccination in a Population at High Risk of Mpox: A Spanish Cohort Study. Clin Infect Dis 2024; 78:476-483. [PMID: 37864849 PMCID: PMC10874271 DOI: 10.1093/cid/ciad645] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/04/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND With more than 7500 cases reported since April 2022, Spain has experienced the highest incidence of mpox in Europe. From 12 July onward, the modified vaccinia Ankara-Bavaria Nordic (MVA-BN) smallpox vaccine was offered as pre-exposure prophylaxis for those receiving pre-exposure prophylaxis for human immunodeficiency virus (HIV-PrEP). Our aim was to assess the effectiveness of 1 dose of MVA-BN vaccine as pre-exposure prophylaxis against mpox virus (MPXV) infection in persons on HIV-PrEP. METHODS National retrospective cohort study between 12 July and 12 December 2022. Individuals aged ≥18 years receiving HIV-PrEP as of 12 July with no previous MPXV infection or vaccination were eligible. Each day, we matched individuals receiving a first dose of vaccine and unvaccinated controls of the same age and region. We used a Kaplan-Meier estimator, calculated risk ratios (RR) and vaccine effectiveness (VE = [1 - RR]x100). RESULTS We included 5660 matched pairs, with a median follow-up of 62 days (interquartile range, 24-97). Mpox cumulative incidence was 5.6 per 1000 (25 cases) in unvaccinated and 3.5 per 1000 (18 cases) in vaccinated. No effect was found during days 0-6 post-vaccination (VE, -38.3; 95% confidence interval [CI], -332.7 to 46.4), but VE was 65% at ≥7 days (95% CI, 22.9 to 88.0) and 79% at ≥14 days (95% CI, 33.3 to 100.0) post-vaccination. CONCLUSIONS One dose of MVA-BN vaccine offered protection against mpox in most-at-risk population shortly after the vaccination. Further studies need to assess the VE of a second dose and the duration of protection over time.
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Affiliation(s)
- Mario Fontán-Vela
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Community of Madrid, Spain
| | - Victoria Hernando
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Carmen Olmedo
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Ermengol Coma
- Primary Healthcare Information Systems, Health Institute of Catalonia, Catalonia, Spain
| | - Montse Martínez
- Preventive Medicine Service, General Sub-directorate for Health Promotion, Health Department, Secretariat of Public Health,Catalonia, Spain
| | - David Moreno-Perez
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - Nicola Lorusso
- Health and Consumption Department, General Directorate of Public Health and Pharmaceutical Management, Andalusia, Spain
| | - María Vázquez Torres
- Healthcare Department, General Sub-directorate of Health Prevention and Promotion, General Directorate of Public Health, Community of Madrid, Spain
| | - José Francisco Barbas del Buey
- General Sub-directorate of Public Health Surveillance, General Directorate of Public Health, Madrid, Community of Madrid, Spain
| | - Javier Roig-Sena
- Department of Universal Healthcare and Public Health, Epidemiological Surveillance Service, Valencian Community, Spain
| | - Eliseo Pastor
- Universal Healthcare and Public Health Department, Health Promotion and Prevention Programs Service, Valencian Community, Spain
| | - Antònia Galmés Truyols
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Francisca Artigues Serra
- Disease Prevention Service, Health and Consumption Department, General Directorate of Public Health and Participation, Balearic Islands, Spain
| | - Rosa María Sancho Martínez
- Epidemiology Unit, General Sub-directorate of Public Health and Addictions of Gipuzkoa, Basque Country, Spain
| | - Pello Latasa Zamalloa
- Epidemiology and Vaccination Service, General Directorate of Public Health, Basque Country, Spain
| | - Olaia Pérez Martínez
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Ana Vázquez Estepa
- Epidemiology Service, Health Department, General Directorate of Public Health, Galicia, Spain
| | - Amós José García Rojas
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | - Ana Isabel Barreno Estévez
- Prevention and Epidemiology Service, General Directorate of Public Health, Canarian Health Service, Canary Islands, Spain
| | | | - Jaime Jesús Pérez Martín
- Vaccination Progamme, Prevention and Health Protection Service, Health Department, General Directorate of Public Health and Addictions, Murcia Region, Spain
| | - Pilar Peces Jiménez
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Raquel Morales Romero
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla-La Mancha, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNA – CIBERESP, Pamplona, Spain
| | | | - Marta Huerta Huerta
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - An Lieve Dirk Boone
- Vaccination Programme, Health Department, Epidemiological Surveillance Service, Principado de Asturias, Spain
| | - María José Macías Ortiz
- Vaccination Program, General Directorate of PublicHealth, Healthcare Service of Extremadura, Spain
| | - Virginia Álvarez Río
- Epidemiology Service, Healthcare Department, General Directorate of Public Health, Castilla y León, Spain
| | | | - María Merino Díaz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | - Belén Berradre Sáenz
- Epidemiology and Healthcare Prevention Service, Health Department, General Directorate of Public Health, Consumption and Nursing, La Rioja, Spain
| | | | - Aurora Limia
- Vaccination Programme, General Directorate of Public Health, Ministry of Health, Madrid, Spain
| | - Asuncion Diaz
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
| | - Susana Monge
- National Centre of Epidemiology, Institute of Health Carlos III, Community of Madrid, Spain
- CIBER on Infectious Diseases, Madrid, Spain
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10
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Maurel M, Howard J, Kissling E, Pozo F, Pérez-Gimeno G, Buda S, Sève N, McKenna A, Meijer A, Rodrigues AP, Martínez-Baz I, Mlinarić I, Latorre-Margalef N, Túri G, Lazăr M, Mazagatos C, Echeverria A, Abela S, Bourgeois M, Machado A, Dürrwald R, Petrović G, Oroszi B, Jancoriene L, Marin A, Husa P, Duffy R, Dijkstra F, Gallardo García V, Goerlitz L, Enouf V, Bennett C, Hooiveld M, Guiomar R, Trobajo-Sanmartín C, Višekruna Vučina V, Samuelsson Hagey T, Lameiras Azevedo AS, Castilla J, Xuereb G, Delaere B, Gómez V, Tolksdorf K, Bacci S, Nicolay N, Kaczmarek M, Rose AM. Interim 2023/24 influenza A vaccine effectiveness: VEBIS European primary care and hospital multicentre studies, September 2023 to January 2024. Euro Surveill 2024; 29:2400089. [PMID: 38390651 PMCID: PMC10899813 DOI: 10.2807/1560-7917.es.2024.29.8.2400089] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/24/2024] Open
Abstract
Influenza A viruses circulated in Europe from September 2023 to January 2024, with influenza A(H1N1)pdm09 predominance. We provide interim 2023/24 influenza vaccine effectiveness (IVE) estimates from two European studies, covering 10 countries across primary care (EU-PC) and hospital (EU-H) settings. Interim IVE was higher against A(H1N1)pdm09 than A(H3N2): EU-PC influenza A(H1N1)pdm09 IVE was 53% (95% CI: 41 to 63) and 30% (95% CI: -3 to 54) against influenza A(H3N2). For EU-H, these were 44% (95% CI: 30 to 55) and 14% (95% CI: -32 to 43), respectively.
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Affiliation(s)
| | | | | | - Francisco Pozo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
| | - Gloria Pérez-Gimeno
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Silke Buda
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Noémie Sève
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Adele McKenna
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Adam Meijer
- National Institute for Public Health and the Environment, Centre for Infectious Diseases Control, Bilthoven, the Netherlands
| | - Ana Paula Rodrigues
- Epidemiology Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA - CIBERESP, Pamplona, Spain
| | - Ivan Mlinarić
- Croatian Institute of Public Health, Zagreb, Croatia
| | | | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Mihaela Lazăr
- Cantacuzino National Military Medical Institute for Research and Development, Bucharest, Romania
| | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Stephen Abela
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | - Marc Bourgeois
- Department of Infectious Diseases, CHU UCL Namur (site Godinne), Université catholique de Louvain, Yvoir, Belgium
| | - Ausenda Machado
- Epidemiology Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Ralf Dürrwald
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | | | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Alexandru Marin
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Petr Husa
- University Hospital Brno and Masaryk University, Brno, Czechia
| | - Roisin Duffy
- HSE Health Protection Surveillance Centre, Dublin, Ireland
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment, Centre for Infectious Diseases Control, Bilthoven, the Netherlands
| | - Virtudes Gallardo García
- Servicio de Vigilancia y Salud Laboral, Dirección General de Salud Pública y Ordenación Farmacéutica, Consejería de Salud y Consumo, Andalucía, Spain
| | - Luise Goerlitz
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Vincent Enouf
- Centre National de Référence Virus des Infections Respiratoire (CNR VIR), Institut Pasteur Université Paris Cité, Paris, France
| | - Charlene Bennett
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | - Raquel Guiomar
- Laboratório Nacional Referência Gripe e outros Vírus Respiratórios, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Ana Sofía Lameiras Azevedo
- Servicio de vigilancia y control epidemiológico, Subdirección general de Epidemiología y Vigilancia de la Salud, Dirección General de Salud pública, Valencia, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA - CIBERESP, Pamplona, Spain
| | - Gerd Xuereb
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | - Bénédicte Delaere
- Department of Infectious Diseases, CHU UCL Namur (site Godinne), Université catholique de Louvain, Yvoir, Belgium
| | - Verónica Gómez
- Epidemiology Department, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Kristin Tolksdorf
- Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marlena Kaczmarek
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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11
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Rose AMC, Pozo F, Martínez-Baz I, Mazagatos C, Bossuyt N, Cauchi JP, Petrović G, Loghin II, Vaikutyte R, Buda S, Machado A, Duffy R, Oroszi B, Howard J, Echeverria A, Andreu C, Barbezange C, Džiugytė A, Nonković D, Popescu CP, Majauskaite F, Tolksdorf K, Gomez V, Domegan L, Horváth JK, Castilla J, García M, Demuyser T, Borg ML, Tabain I, Lazar M, Kubiliute I, Dürrwald R, Guiomar R, O'Donnell J, Kristóf K, Nicolay N, Bacci S, Kissling E. Vaccine effectiveness against influenza hospitalisation in adults during the 2022/2023 mixed season of influenza A(H1N1)pdm09, A(H3N2) and B circulation, Europe: VEBIS SARI VE hospital network. Influenza Other Respir Viruses 2024; 18:e13255. [PMID: 38403302 PMCID: PMC10894713 DOI: 10.1111/irv.13255] [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: 10/09/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 02/27/2024] Open
Abstract
We conducted a multicentre hospital-based test-negative case-control study to measure vaccine effectiveness (VE) against PCR-confirmed influenza in adult patients with severe acute respiratory infection (SARI) during the 2022/2023 influenza season in Europe. Among 5547 SARI patients ≥18 years, 2963 (53%) were vaccinated against influenza. Overall VE against influenza A(H1N1)pdm09 was 11% (95% CI: -23-36); 20% (95% CI: -4-39) against A(H3N2) and 56% (95% CI: 22-75) against B. During the 2022/2023 season, while VE against hospitalisation with influenza B was >55%, it was ≤20% for influenza A subtypes. While influenza vaccination should be a priority for future seasons, improved vaccines against influenza are needed.
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Affiliation(s)
| | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Iván Martínez-Baz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - John Paul Cauchi
- Department for Health Regulation, Health Promotion and Disease Prevention, Msida, Malta
| | | | - Isabela I Loghin
- St Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
| | | | | | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Aitziber Echeverria
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
| | - Cristina Andreu
- Subdirección de Epidemiología, Dirección General de Salud Pública, Servicio Extremeño de Salud, Mérida, Spain
| | | | - Aušra Džiugytė
- Department for Health Regulation, Health Promotion and Disease Prevention, Msida, Malta
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Corneliu-Petru Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Fausta Majauskaite
- Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Verónica Gomez
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
| | - Miriam García
- Dirección General de Salud Pública, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, Spain
| | - Thomas Demuyser
- Department of Microbiology and Infection control, UZ Brussel, Brussels, Belgium
| | - Maria-Louise Borg
- Department for Health Regulation, Health Promotion and Disease Prevention, Msida, Malta
| | - Irena Tabain
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Mihaela Lazar
- "Cantacuzino" National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Ieva Kubiliute
- Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | | | - Raquel Guiomar
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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12
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Martínez-Baz I, Trobajo-Sanmartín C, Miqueleiz A, Egüés N, García Cenoz M, Casado I, Navascués A, Fernández-Huerta M, Echeverría A, Guevara M, Ezpeleta C, Castilla J. Hospitalisations and Deaths Averted by COVID-19 Vaccination in Navarre, Spain, 2021-2022. Vaccines (Basel) 2024; 12:58. [PMID: 38250871 PMCID: PMC10818920 DOI: 10.3390/vaccines12010058] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
In 2021-2022, most of the Spanish population received COVID-19 vaccines and a high proportion of them had SARS-CoV-2 infection. We estimated the rate of hospitalisations and deaths that were averted by risk reduction among vaccinated COVID-19 cases. Hospitalisations and deaths were analysed among COVID-19 cases confirmed in 2021 and 2022 in Navarre, Spain. To calculate the number of prevented outcomes by sex, age, comorbidities, and semester, the difference in the risk of each outcome between unvaccinated and vaccinated cases was multiplied by the number of vaccinated cases. COVID-19 vaccination coverage with any dose reached 88%, 86% with full vaccination, and 56% with a booster dose. The cumulative rates per 1000 inhabitants were 382 COVID-19 confirmed cases, 6.70 hospitalisations, and 1.15 deaths from COVID-19. The estimated rates of prevented events by vaccination were 16.33 hospitalisations and 3.39 deaths per 1000 inhabitants, which was 70.9% and 74.7% of expected events without vaccination, respectively. People aged 80 years and older or with major chronic conditions accounted for the majority of hospitalizations and deaths prevented by COVID-19 vaccination. One hospitalisation and death due to COVID-19 were averted for every 53 and 258 people vaccinated, respectively. The high COVID-19 vaccine effect in reducing the risk of severe outcomes and the high vaccination coverage in risk populations prevented three out of four hospitalisations and deaths due to COVID-19 during a period of intense circulation of SARS-CoV-2.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Ana Miqueleiz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Nerea Egüés
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Ana Navascués
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Miguel Fernández-Huerta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Aitziber Echeverría
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Carmen Ezpeleta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
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13
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Antunes L, Mazagatos C, Martínez-Baz I, Gomez V, Borg ML, Petrović G, Duffy R, Dufrasne FE, Dürrwald R, Lazar M, Jancoriene L, Oroszi B, Husa P, Howard J, Melo A, Pozo F, Pérez-Gimeno G, Castilla J, Machado A, Džiugytė A, Karabuva S, Fitzgerald M, Fierens S, Tolksdorf K, Popovici SO, Mickienė A, Túri G, Součková L, Nicolay N, Rose AM. Effectiveness of the adapted bivalent mRNA COVID-19 vaccines against hospitalisation in individuals aged ≥ 60 years during the Omicron XBB lineage-predominant period: VEBIS SARI VE network, Europe, February to August, 2023. Euro Surveill 2024; 29:2300708. [PMID: 38240061 PMCID: PMC10797659 DOI: 10.2807/1560-7917.es.2024.29.3.2300708] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 01/22/2024] Open
Abstract
We conducted a multicentre hospital-based test-negative case-control study to measure the effectiveness of adapted bivalent COVID-19 mRNA vaccines against PCR-confirmed SARS-CoV-2 infection during the Omicron XBB lineage-predominant period in patients aged ≥ 60 years with severe acute respiratory infection from five countries in Europe. Bivalent vaccines provided short-term additional protection compared with those vaccinated > 6 months before the campaign: from 80% (95% CI: 50 to 94) for 14-89 days post-vaccination, 15% (95% CI: -12 to 35) at 90-179 days, and lower to no effect thereafter.
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Affiliation(s)
| | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Verónica Gomez
- Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Maria-Louise Borg
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | | | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - François E Dufrasne
- National Influenza Centre Laboratory of Viral Diseases, Sciensano, Brussels, Belgium
| | - Ralf Dürrwald
- National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany
| | - Mihaela Lazar
- Cantacuzino National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Ligita Jancoriene
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Lithuania
| | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Petr Husa
- University Hospital Brno, Masaryk University, Brno, Czechia
| | | | - Aryse Melo
- Infectious Diseases Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Gloria Pérez-Gimeno
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Ausenda Machado
- Epidemiology Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Aušra Džiugytė
- Infectious Disease Prevention and Control Unit (IDCU), Health Promotion and Disease Prevention, Msida, Malta
| | | | - Margaret Fitzgerald
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Sébastien Fierens
- Service Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium
| | - Kristin Tolksdorf
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Silvia-Odette Popovici
- National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, Bucharest, Romania
| | - Auksė Mickienė
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Lenka Součková
- University Hospital Brno, Masaryk University, Brno, Czechia
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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14
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Maurel M, Pozo F, Pérez‐Gimeno G, Buda S, Sève N, Oroszi B, Hooiveld M, Gomez V, Domegan L, Martínez‐Baz I, Ilić M, Carnahan AS, Mihai ME, Martínez A, Goerlitz L, Enouf V, Horváth JK, Dijkstra F, Rodrigues AP, Bennett C, Trobajo‐Sanmartín C, Mlinarić I, Latorre‐Margalef N, Ivanciuc A, Lopez A, Dürrwald R, Falchi A, Túri G, Meijer A, Melo A, O'Donnell J, Castilla J, Vučina VV, Hagey TS, Lazar M, Kaczmarek M, Bacci S, Kissling E. Influenza vaccine effectiveness in Europe: Results from the 2022-2023 VEBIS (Vaccine Effectiveness, Burden and Impact Studies) primary care multicentre study. Influenza Other Respir Viruses 2024; 18:e13243. [PMID: 38204584 PMCID: PMC10777262 DOI: 10.1111/irv.13243] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 01/12/2024] Open
Abstract
Background Influenza A(H3N2) viruses dominated early in the 2022-2023 influenza season in Europe, followed by higher circulation of influenza A(H1N1)pdm09 and B viruses. The VEBIS primary care network estimated the influenza vaccine effectiveness (VE) using a multicentre test-negative study. Materials and Methods Primary care practitioners collected information and specimens from patients consulting with acute respiratory infection. We measured VE against any influenza, influenza (sub)type and clade, by age group, by influenza vaccine target group and by time since vaccination, using logistic regression. Results We included 38 058 patients, of which 3786 were influenza A(H3N2), 1548 influenza A(H1N1)pdm09 and 3275 influenza B cases. Against influenza A(H3N2), VE was 36% (95% CI: 25-45) among all ages and ranged between 30% and 52% by age group and target group. VE against influenza A(H3N2) clade 2b was 38% (95% CI: 25-49). Overall, VE against influenza A(H1N1)pdm09 was 46% (95% CI: 35-56) and ranged between 29% and 59% by age group and target group. VE against influenza A(H1N1)pdm09 clade 5a.2a was 56% (95% CI: 46-65) and 79% (95% CI: 64-88) against clade 5a.2a.1. VE against influenza B was 76% (95% CI: 70-81); overall, 84%, 72% and 71% were among 0-14-year-olds, 15-64-year-olds and those in the influenza vaccination target group, respectively. VE against influenza B with a position 197 mutation of the hemagglutinin (HA) gene was 79% (95% CI: 73-85) and 90% (95% CI: 85-94) without this mutation. Conclusion The 2022-2023 end-of-season results from the VEBIS network at primary care level showed high VE among children and against influenza B, with lower VE against influenza A(H1N1)pdm09 and A(H3N2).
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Affiliation(s)
| | - Francisco Pozo
- National Centre for MicrobiologyInstitute of Health Carlos IIIMadridSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Gloria Pérez‐Gimeno
- National Centre for MicrobiologyInstitute of Health Carlos IIIMadridSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Silke Buda
- Department for Infectious Disease Epidemiology, Respiratory Infections UnitRobert Koch InstituteBerlinGermany
| | - Noémie Sève
- Sorbonne UniversitéINSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136)ParisFrance
| | - Beatrix Oroszi
- National Laboratory for Health Security, Epidemiology and Surveillance CentreSemmelweis UniversityBudapestHungary
| | | | - Verónica Gomez
- Instituto Nacional de Saúde Dr. Ricardo JorgeLisbonPortugal
| | - Lisa Domegan
- HSE‐Health Protection Surveillance CentreDublinIreland
| | - Iván Martínez‐Baz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
- Instituto de Salud Pública de Navarra (IdiSNA)PamplonaSpain
| | - Maja Ilić
- Croatian Institute of Public HealthZagrebCroatia
| | | | - Maria Elena Mihai
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Ana Martínez
- Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública, Agencia de Salud Pública de CatalunyaBarcelonaSpain
| | - Luise Goerlitz
- Department for Infectious Disease Epidemiology, Respiratory Infections UnitRobert Koch InstituteBerlinGermany
| | - Vincent Enouf
- Centre National de Référence Virus des Infections Respiratoire (CNR VIR), Institut PasteurParisFrance
| | - Judit Krisztina Horváth
- National Laboratory for Health Security, Epidemiology and Surveillance CentreSemmelweis UniversityBudapestHungary
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM)Bilthoventhe Netherlands
| | | | - Charlene Bennett
- National Virus Reference LaboratoryUniversity College DublinDublinIreland
| | - Camino Trobajo‐Sanmartín
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
- Instituto de Salud Pública de Navarra (IdiSNA)PamplonaSpain
| | | | | | - Alina Ivanciuc
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Aurora Lopez
- Subdirección General de Epidemiologia y Vigilancia de la SaludValenciaSpain
| | - Ralf Dürrwald
- National Reference Centre for InfluenzaRobert Koch InstituteBerlinGermany
| | | | - Gergő Túri
- National Laboratory for Health Security, Epidemiology and Surveillance CentreSemmelweis UniversityBudapestHungary
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM)Bilthoventhe Netherlands
| | - Aryse Melo
- Instituto Nacional de Saúde Dr. Ricardo JorgeLisbonPortugal
| | | | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
- Instituto de Salud Pública de Navarra (IdiSNA)PamplonaSpain
| | | | | | - Mihaela Lazar
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | | | - Sabrina Bacci
- European Centre for Disease Prevention and ControlStockholmSweden
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15
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Fontán-Vela M, Kissling E, Nicolay N, Braeye T, Van Evercooren I, Holm Hansen C, Emborg HD, Fabiani M, Mateo-Urdiales A, AlKerwi A, Schmitz S, Castilla J, Martínez-Baz I, de Gier B, Hahné S, Meijerink H, Starrfelt J, Nunes B, Caetano C, Derrough T, Nardone A, Monge S. Relative vaccine effectiveness against COVID-19 hospitalisation in persons aged ≥ 65 years: results from a VEBIS network, Europe, October 2021 to July 2023. Euro Surveill 2024; 29:2300670. [PMID: 38179626 PMCID: PMC10905661 DOI: 10.2807/1560-7917.es.2024.29.1.2300670] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
To monitor relative vaccine effectiveness (rVE) against COVID-19-related hospitalisation of the first, second and third COVID-19 booster (vs complete primary vaccination), we performed monthly Cox regression models using retrospective cohorts constructed from electronic health registries in eight European countries, October 2021-July 2023. Within 12 weeks of administration, each booster showed high rVE (≥ 70% for second and third boosters). However, as of July 2023, most of the relative benefit has waned, particularly in persons ≥ 80-years-old, while some protection remained in 65-79-year-olds.
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Affiliation(s)
- Mario Fontán-Vela
- National Centre of Epidemiology, Carlos III National Health Institute (ISCIII), Madrid, Spain
- Public Health and Epidemiology research group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | | | - Nathalie Nicolay
- Vaccine Preventable Diseases and Immunisation, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | | | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut (SSI), Copenhagen, Denmark
| | - Massimo Fabiani
- Infectious Diseases Department, Istituto Superiore di Sanità, Rome, Italy
| | | | - Ala'a AlKerwi
- Ministry of Health, Directorate of Health, Service epidemiology and statistics, Luxembourg
| | - Susanne Schmitz
- Ministry of Health, Directorate of Health, Service epidemiology and statistics, Luxembourg
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
| | - Iván Martínez-Baz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain
| | - Brechje de Gier
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Susan Hahné
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Departamento de Epidemiologia, Lisboa, Portugal
| | - Constantino Caetano
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Departamento de Epidemiologia, Lisboa, Portugal
| | - Tarik Derrough
- Vaccine Preventable Diseases and Immunisation, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Susana Monge
- National Centre of Epidemiology, Carlos III National Health Institute (ISCIII), Madrid, Spain
- CIBER on Infectious Diseases (CIBERINFEC), Madrid, Spain
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16
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Martínez-Baz I, Bullón-Vela V, Soldevila N, Torner N, Palma D, García Cenoz M, Pérez G, Burgui C, Castilla J, Godoy P, Domínguez A, Toledo D. Assessment of Knowledge and Attitudes Over Time in Postacute COVID-19 Environments: Protocol for an Epidemiological Study. JMIR Res Protoc 2023; 12:e52114. [PMID: 37995118 DOI: 10.2196/52114] [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: 08/23/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Globally, COVID-19 is in transition from the acute pandemic phase into a postacute phase, and special attention should be paid at this time to COVID-19 control strategies. Understanding public knowledge and attitudes plays a pivotal role in controlling COVID-19's spread and provides information about the public's adherence to preventive and control measures. OBJECTIVE This study protocol describes the planning and management of a survey to investigate the persistent or changing trends in knowledge and attitudes regarding COVID-19, vaccination, and nonpharmaceutical preventive measures among COVID-19 cases' household contacts aged 18 years and older, after the acute phase of the pandemic in Catalonia and Navarre in Spain. The secondary objectives include investigating the rate of secondary transmission in households, taking into account the demographic characteristics, clinical manifestations, and preventive measures toward COVID-19. METHODS A telephone questionnaire was designed to assess the changing trends in knowledge, preventive measures, and attitudes toward COVID-19 in 3 rounds (after identification as a household contact, 3 months later, and 6 months later). The questionnaire was developed following an extensive literature review and through discussions with a panel of experts who designed and assessed the validity of the questionnaire in terms of relevance, consistency, completeness, and clarity. The questionnaire consists of the following 7 sections: social and demographic characteristics (ie, gender, age, educational level, and workplace), comorbidities and risk factors (according to the recommendations from the COVID-19 vaccination strategy), epidemiological data (ie, exposure time, relationship with index cases, and frequency of use of nonpharmaceutical preventive measures), COVID-19 vaccination status (ie, the number and date of doses received), knowledge and attitudes toward COVID-19 (assessed using a 5-point Likert scale-totally agree, agree, neither agree nor disagree, disagree, and totally disagree), and sources of information (including traditional mass media, social media, and official sources). RESULTS A pilot study was performed in May 2022 to evaluate the questionnaire with 22 household contacts. Preliminary findings indicated that the questionnaire was feasible and acceptable in the general population. The average response time was 15 minutes, with greater variations in responses by older participants. After the pilot study, recruitment of participants began and is expected to be completed at the end of the year 2023, after which the final results will be available in 2024. CONCLUSIONS Despite the low transmission levels of SARS-CoV-2 and the relaxation of containment measures, the implementation of the survey during the postacute phase will provide valuable insight to assist public health decision-making and control the transmission of SARS-CoV-2 and other respiratory viruses, thereby attenuating the negative effects of COVID-19 at individual and population level. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52114.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Vanessa Bullón-Vela
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Núria Soldevila
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Núria Torner
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - David Palma
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Glòria Pérez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pombeu Fabra, Barcelona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Pere Godoy
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Universitat de Lleida, Catalonia, Spain
- Institut de Recerca Biomèdica de Lleida, Catalonia, Spain
| | - Angela Domínguez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Diana Toledo
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Universitat de Barcelona, Barcelona, Spain
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17
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Rose AM, Nicolay N, Sandonis Martín V, Mazagatos C, Petrović G, Baruch J, Denayer S, Seyler L, Domegan L, Launay O, Machado A, Burgui C, Vaikutyte R, Niessen FA, Loghin II, Husa P, Aouali N, Panagiotakopoulos G, Tolksdorf K, Horváth JK, Howard J, Pozo F, Gallardo V, Nonković D, Džiugytė A, Bossuyt N, Demuyser T, Duffy R, Luong Nguyen LB, Kislaya I, Martínez-Baz I, Gefenaite G, Knol MJ, Popescu C, Součková L, Simon M, Michelaki S, Reiche J, Ferenczi A, Delgado-Sanz C, Lovrić Makarić Z, Cauchi JP, Barbezange C, Van Nedervelde E, O'Donnell J, Durier C, Guiomar R, Castilla J, Jonikaite I, Bruijning-Verhagen PC, Lazar M, Demlová R, Wirtz G, Amerali M, Dürrwald R, Kunstár MP, Kissling E, Bacci S, Valenciano M. Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Omicron-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021 to 2022. Euro Surveill 2023; 28:2300187. [PMID: 37997665 PMCID: PMC10668256 DOI: 10.2807/1560-7917.es.2023.28.47.2300187] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 11/25/2023] Open
Abstract
IntroductionThe I-MOVE-COVID-19 and VEBIS hospital networks have been measuring COVID-19 vaccine effectiveness (VE) in participating European countries since early 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in patients ≥ 20 years hospitalised with severe acute respiratory infection (SARI) from December 2021 to July 2022 (Omicron-dominant period).MethodsIn both networks, 46 hospitals (13 countries) follow a similar test-negative case-control protocol. We defined complete primary series vaccination (PSV) and first booster dose vaccination as last dose of either vaccine received ≥ 14 days before symptom onset (stratifying first booster into received < 150 and ≥ 150 days after last PSV dose). We measured VE overall, by vaccine category/product, age group and time since first mRNA booster dose, adjusting by site as a fixed effect, and by swab date, age, sex, and presence/absence of at least one commonly collected chronic condition.ResultsWe included 2,779 cases and 2,362 controls. The VE of all vaccine products combined against hospitalisation for laboratory-confirmed SARS-CoV-2 was 43% (95% CI: 29-54) for complete PSV (with last dose received ≥ 150 days before onset), while it was 59% (95% CI: 51-66) after addition of one booster dose. The VE was 85% (95% CI: 78-89), 70% (95% CI: 61-77) and 36% (95% CI: 17-51) for those with onset 14-59 days, 60-119 days and 120-179 days after booster vaccination, respectively.ConclusionsOur results suggest that, during the Omicron period, observed VE against SARI hospitalisation improved with first mRNA booster dose, particularly for those having symptom onset < 120 days after first booster dose.
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Affiliation(s)
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Joaquin Baruch
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Odile Launay
- Inserm, CIC Cochin-Pasteur, Paris, France
- AP-HP, Hôpital Cochin, Paris, France
- Faculty of Medicine, University of Paris City, Paris, France
| | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - F Annabel Niessen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Isabela I Loghin
- St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Petr Husa
- Faculty of Medicine, Masaryk University, Brno, Czechia
- University Hospital Brno, Brno, Czechia
| | | | | | | | - Judit Krisztina Horváth
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Virtudes Gallardo
- Dirección General de Salud Pública y Ordenación Farmacéutica, Junta de Andalucía, Spain
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Aušra Džiugytė
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | | | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Irina Kislaya
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Giedre Gefenaite
- Faculty of Medicine, Lund University, Lund, Sweden
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Corneliu Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Marc Simon
- Centre Hospitalier de Luxembourg, Luxembourg
| | | | | | - Annamária Ferenczi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Concepción Delgado-Sanz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - John Paul Cauchi
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | | | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Raquel Guiomar
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Patricia Cjl Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mihaela Lazar
- "Cantacuzino" National Military Medical Institute for Research-Development, Bucharest, Romania
| | | | - Gil Wirtz
- Centre Hospitalier de Luxembourg, Luxembourg
| | - Marina Amerali
- National Public Health Organisation (EODY), Athens, Greece
| | | | - Mihály Pál Kunstár
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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18
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Rose AM, Nicolay N, Sandonis Martín V, Mazagatos C, Petrović G, Niessen FA, Machado A, Launay O, Denayer S, Seyler L, Baruch J, Burgui C, Loghin II, Domegan L, Vaikutytė R, Husa P, Panagiotakopoulos G, Aouali N, Dürrwald R, Howard J, Pozo F, Sastre-Palou B, Nonković D, Knol MJ, Kislaya I, Luong Nguyen LB, Bossuyt N, Demuyser T, Džiugytė A, Martínez-Baz I, Popescu C, Duffy R, Kuliešė M, Součková L, Michelaki S, Simon M, Reiche J, Otero-Barrós MT, Lovrić Makarić Z, Bruijning-Verhagen PC, Gomez V, Lesieur Z, Barbezange C, Van Nedervelde E, Borg ML, Castilla J, Lazar M, O'Donnell J, Jonikaitė I, Demlová R, Amerali M, Wirtz G, Tolksdorf K, Valenciano M, Bacci S, Kissling E. Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Alpha- and Delta-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021. Euro Surveill 2023; 28:2300186. [PMID: 37997666 PMCID: PMC10668259 DOI: 10.2807/1560-7917.es.2023.28.47.2300186] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 11/25/2023] Open
Abstract
IntroductionTwo large multicentre European hospital networks have estimated vaccine effectiveness (VE) against COVID-19 since 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in hospitalised severe acute respiratory illness (SARI) patients ≥ 20 years, combining data from these networks during Alpha (March-June)- and Delta (June-December)-dominant periods, 2021.MethodsForty-six participating hospitals across 14 countries follow a similar generic protocol using the test-negative case-control design. We defined complete primary series vaccination (PSV) as two doses of a two-dose or one of a single-dose vaccine ≥ 14 days before onset.ResultsWe included 1,087 cases (538 controls) and 1,669 cases (1,442 controls) in the Alpha- and Delta-dominant periods, respectively. During the Alpha period, VE against hospitalisation with SARS-CoV2 for complete Comirnaty PSV was 85% (95% CI: 69-92) overall and 75% (95% CI: 42-90) in those aged ≥ 80 years. During the Delta period, among SARI patients ≥ 20 years with symptom onset ≥ 150 days from last PSV dose, VE for complete Comirnaty PSV was 54% (95% CI: 18-74). Among those receiving Comirnaty PSV and mRNA booster (any product) ≥ 150 days after last PSV dose, VE was 91% (95% CI: 57-98). In time-since-vaccination analysis, complete all-product PSV VE was > 90% in those with their last dose < 90 days before onset; ≥ 70% in those 90-179 days before onset.ConclusionsOur results from this EU multi-country hospital setting showed that VE for complete PSV alone was higher in the Alpha- than the Delta-dominant period, and addition of a first booster dose during the latter period increased VE to over 90%.
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Affiliation(s)
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - F Annabel Niessen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Odile Launay
- Inserm, CIC Cochin-Pasteur, Paris, France
- AP-HP, Hôpital Cochin, Paris, France
- Faculty of Medicine, University of Paris City, Paris, France
| | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Joaquin Baruch
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Isabela I Loghin
- St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Petr Husa
- Faculty of Medicine, Masaryk University, Brno, Czechia
- University Hospital Brno, Brno, Czechia
| | | | | | | | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Bartolomé Sastre-Palou
- Servicio de Medicina Preventiva Hospital Universitario Son Espases, Servicio de Epidemiología, Consellería de Salut, Palma, Spain
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Irina Kislaya
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Aušra Džiugytė
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Corneliu Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Monika Kuliešė
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Marc Simon
- Centre Hospitalier de Luxembourg, Luxembourg
| | | | - María Teresa Otero-Barrós
- Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad de Galicia, Santiago de Compostela, A Coruna, Spain
| | | | - Patricia Cjl Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Verónica Gomez
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Maria-Louise Borg
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mihaela Lazar
- "Cantacuzino" National Military Medical Institute for Research-Development, Bucharest, Romania
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Marina Amerali
- National Public Health Organisation (EODY), Athens, Greece
| | - Gil Wirtz
- Luxembourg Institute of Health, Luxembourg
| | | | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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19
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Kislaya I, Sentís A, Starrfelt J, Nunes B, Martínez‐Baz I, Nielsen KF, AlKerwi A, Braeye T, Fontán‐Vela M, Bacci S, Meijerink H, Castilla J, Emborg H, Hansen CH, Schmitz S, Van Evercooren I, Valenciano M, Nardone A, Nicolay N, Monge S. Monitoring COVID-19 vaccine effectiveness against COVID-19 hospitalisation and death using electronic health registries in ≥65 years old population in six European countries, October 2021 to November 2022. Influenza Other Respir Viruses 2023; 17:e13195. [PMID: 38019704 PMCID: PMC10682901 DOI: 10.1111/irv.13195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/27/2023] [Revised: 08/14/2023] [Accepted: 08/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Within the ECDC-VEBIS project, we prospectively monitored vaccine effectiveness (VE) against COVID-19 hospitalisation and COVID-19-related death using electronic health registries (EHR), between October 2021 and November 2022, in community-dwelling residents aged 65-79 and ≥80 years in six European countries. METHODS EHR linkage was used to construct population cohorts in Belgium, Denmark, Luxembourg, Navarre (Spain), Norway and Portugal. Using a common protocol, for each outcome, VE was estimated monthly over 8-week follow-up periods, allowing 1 month-lag for data consolidation. Cox proportional-hazards models were used to estimate adjusted hazard ratios (aHR) and VE = (1 - aHR) × 100%. Site-specific estimates were pooled using random-effects meta-analysis. RESULTS For ≥80 years, considering unvaccinated as the reference, VE against COVID-19 hospitalisation decreased from 66.9% (95% CI: 60.1; 72.6) to 36.1% (95% CI: -27.3; 67.9) for the primary vaccination and from 95.6% (95% CI: 88.0; 98.4) to 67.7% (95% CI: 45.9; 80.8) for the first booster. Similar trends were observed for 65-79 years. The second booster VE against hospitalisation ranged between 82.0% (95% CI: 75.9; 87.0) and 83.9% (95% CI: 77.7; 88.4) for the ≥80 years and between 39.3% (95% CI: -3.9; 64.5) and 80.6% (95% CI: 67.2; 88.5) for 65-79 years. The first booster VE against COVID-19-related death declined over time for both age groups, while the second booster VE against death remained above 80% for the ≥80 years. CONCLUSIONS Successive vaccine boosters played a relevant role in maintaining protection against COVID-19 hospitalisation and death, in the context of decreasing VE over time. Multicountry data from EHR facilitate robust near-real-time VE monitoring in the EU/EEA and support public health decision-making.
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Affiliation(s)
- Irina Kislaya
- Department of EpidemiologyInstituto Nacional de Saúde Doutor Ricardo Jorge (INSA)LisbonPortugal
| | | | | | - Baltazar Nunes
- Department of EpidemiologyInstituto Nacional de Saúde Doutor Ricardo Jorge (INSA)LisbonPortugal
| | - Iván Martínez‐Baz
- Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
- CIBER on Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Katrine Finderup Nielsen
- Department of Infectious Disease Epidemiology & PreventionStatens Serum Institut (SSI)CopenhagenDenmark
| | - Ala'a AlKerwi
- Ministry of Health, Directorate of Health, Service Epidemiology and StatisticsLuxembourgLuxembourg
| | - Toon Braeye
- Epidemiology of infectious diseases, SciensanoBrusselsBelgium
| | - Mario Fontán‐Vela
- Instituto de Salud Carlos III (ISCIII), MadridSpain
- Public Health and Epidemiology research groupSchool of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de HenaresMadridSpain
| | - Sabrina Bacci
- Vaccine Preventable Diseases and ImmunisationEuropean Centre for Disease Prevention and Control (ECDC)SolnaSweden
| | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
- CIBER on Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Hanne‐Dorthe Emborg
- Department of Infectious Disease Epidemiology & PreventionStatens Serum Institut (SSI)CopenhagenDenmark
| | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology & PreventionStatens Serum Institut (SSI)CopenhagenDenmark
| | - Susanne Schmitz
- Ministry of Health, Directorate of Health, Service Epidemiology and StatisticsLuxembourgLuxembourg
| | | | | | | | - Nathalie Nicolay
- Vaccine Preventable Diseases and ImmunisationEuropean Centre for Disease Prevention and Control (ECDC)SolnaSweden
| | - Susana Monge
- Instituto de Salud Carlos III (ISCIII), MadridSpain
- CIBER on Infectious Diseases (CIBERINFEC)MadridSpain
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20
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Caballero P, Astray J, Domínguez Á, Godoy P, Barrabeig I, Castilla J, Tuells J. [Validation of the questionnaire on vaccines and hesitancy to be vaccinated in the Spanish Society of Epidemiology]. Gac Sanit 2023; 37:102329. [PMID: 37820503 DOI: 10.1016/j.gaceta.2023.102329] [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: 04/20/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To develop and validate a survey aimed at epidemiologists to measure factors associated with vaccine reluctance. METHOD Vaccination hesitancy refers to delayed acceptance or refusal of vaccination despite the availability of vaccination services. WHO included vaccination hesitancy among the 10 global health threats in 2019. Within this conceptual framework proposed by WHO, a committee of six experts from the Spanish Society of Epidemiology (SEE) designed a self-administered questionnaire to study factors associated with vaccination hesitancy in epidemiologists. This questionnaire was approved by the SEE Board, and was sent online to all members in 2019. Based on the responses obtained, the following characteristics were validated: face validity, internal validity, construct validity, criterion validity, reliability, as well as the characteristic curves of each item and the information function per item and overall. RESULTS The final questionnaire showed two well-defined components, perception of vaccines and confidence in the transparency of vaccine data with high degrees of fit in all aspects of validation. Both components have shown that the higher the reluctance to vaccinate the better the questionnaire reports on these aspects. CONCLUSIONS The study has allowed the development of a validated instrument in Spanish to measure the factors associated with vaccine reluctance among epidemiologists.
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Affiliation(s)
- Pablo Caballero
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universitat d'Alacant, Alicante, España
| | - Jenaro Astray
- Dirección General de Salud Pública, Subdirección General de Epidemiología, Comunidad de Madrid, Madrid, España
| | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departament de Medicina, Universitat de Barcelona, Barcelona, España
| | - Pere Godoy
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Catalunya, Barcelona, España; Institut de Recerca Biomèdica de Lleida, Lleida, España
| | - Irene Barrabeig
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Agència de Salut Pública de Catalunya, Barcelona, España
| | - Jesús Castilla
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, España
| | - José Tuells
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universitat d'Alacant, Alicante, España.
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21
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Martínez-Baz I, Fernández-Huerta M, Navascués A, Pozo F, Trobajo-Sanmartín C, Casado I, Echeverria A, Ezpeleta C, Castilla J. Influenza Vaccine Effectiveness in Preventing Laboratory-Confirmed Influenza Cases and Hospitalizations in Navarre, Spain, 2022-2023. Vaccines (Basel) 2023; 11:1478. [PMID: 37766154 PMCID: PMC10534462 DOI: 10.3390/vaccines11091478] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
We estimated influenza vaccine effectiveness (IVE) in preventing outpatient and hospitalized cases in the 2022-2023 season. A test-negative design included a representative sample of outpatients and all hospitalized patients with influenza-like illness (ILI) from October 2022 to May 2023 in Navarre, Spain. ILI patients were tested by PCR for influenza virus. Influenza vaccination status was compared between confirmed influenza cases and test-negative controls. Among 3321 ILI patients tested, IVE to prevent influenza cases was 34% (95% confidence interval (CI): 16 to 48) overall, 85% (95%CI: 63 to 94) against influenza B, and 28% (95%CI: 3 to 46) against A(H3N2). Among 558 outpatients, 222 (40%) were confirmed for influenza: 55% A(H3N2), 11% A(H1N1), and 31% B. Overall, IVE to prevent outpatient cases was 48% (95%CI: 8 to 70), 88% (95%CI: 3 to 98) against influenza B, and 50% (95%CI: -4 to 76) against A(H3N2). Of 2763 hospitalized patients, 349 (13%) were positive for influenza: 64% A(H3N2), 17% A(H1N1), and 8% B. IVE to prevent hospitalization was 24% (95%CI: -1 to 42) overall, 82% (95%CI: 49 to 93) against influenza B, and 16% (95%CI: -17 to 40) against A(H3N2). No IVE was observed in preventing influenza A(H1N1). IVE was high to prevent influenza B, moderate against A(H3N2) and null against A(H1N1). A lower proportion of influenza B cases may explain the smaller IVE in hospitalized patients than in outpatients. The null IVE against A(H1N1) was consistent with the observed antigenic drift and supports the new composition of the 2023-2024 influenza vaccine.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (I.C.); (A.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
| | - Miguel Fernández-Huerta
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Ana Navascués
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Francisco Pozo
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- National Centre for Microbiology, Instituto de Salud Carlos III, 28222 Majadahonda, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (I.C.); (A.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (I.C.); (A.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
| | - Aitziber Echeverria
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (I.C.); (A.E.)
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
| | - Carmen Ezpeleta
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (I.C.); (A.E.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain;
- Navarre Institute for Health Research (IdiSNA), 31008 Pamplona, Spain; (M.F.-H.); (C.E.)
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22
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Casado I, García Cenoz M, Egüés N, Burgui C, Martínez-Baz I, Castilla J. [COVID-19 infections, hospitalizations, and mortality in Navarre (Spain) between February 2020 and September 2022]. An Sist Sanit Navar 2023; 46:e1044. [PMID: 37594061 PMCID: PMC10498135 DOI: 10.23938/assn.1044] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Between February 2020 and September 2022, SARS-CoV-2 has circulated uninterruptedly throughout Spain. This study analyses COVID-19 infections, hospitalizations, and deaths in Navarre. METHODS Enhanced epidemiological surveillance and results of seroepidemiological surveys were used to analyze COVID-19 infections, hospitalizations, and deaths, based on the vaccination coverage and other preventive measures applied from February 2020 to September 2022. RESULTS A total of 295,424 COVID-19 cases were confirmed (45% of the population in Navarre); 8,594 required hospital admission (1.3%), 832 were admitted to intensive care units (1.3‰) and 1,725 died (2.6‰). Over the first wave of the pandemic, there were 1,934 hospitalizations and 529 deaths from confirmed COVID-19 cases over a few weeks; these figures dropped rapidly following lockdown. Until October 2021, SARS-CoV-2 circulation was modulated by non-pharmacological preventive measures. The subsequent relaxation of these measures led to a wide circulation of the omicron variant, increasing the number of cases by three-fold. The high vaccination coverage against COVID-19 introduced decisive changes in the epidemiology of the disease, reducing to less than 2%, 0.1%, and 0.5% the cases requiring hospitalization, intensive care unit admission, or that died, respectively. CONCLUSIONS Initial lockdown and non-pharmacological preventive measures helped control SARS-CoV-2 transmission until vaccination was extended. Vaccination achieved a decisive reduction of the COVID-19 severity and lethality.
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23
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Castilla J, Cenoz MG, Barricarte A. Meningococcal Group B Vaccine (4CMenB) in Children. Reply. N Engl J Med 2023; 388:2109. [PMID: 37256992 DOI: 10.1056/nejmc2303518] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jesús Castilla
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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24
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Martínez-Baz I, Miqueleiz A, Egüés N, Casado I, Burgui C, Echeverría A, Navascués A, Fernández-Huerta M, García Cenoz M, Trobajo-Sanmartín C, Guevara M, Ezpeleta C, Castilla J. Effect of COVID-19 vaccination on the SARS-CoV-2 transmission among social and household close contacts: A cohort study. J Infect Public Health 2023; 16:410-417. [PMID: 36724697 PMCID: PMC9876028 DOI: 10.1016/j.jiph.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/24/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND COVID-19 vaccination was expected to reduce SARS-CoV-2 transmission, but the relevance of this effect remains unclear. We aimed to estimate the effectiveness of COVID-19 vaccination of the index cases and their close contacts in reducing the probability of SARS-CoV-2 transmission. METHODS Transmission of SARS-CoV-2 infection was evaluated in two cohorts of adult close contacts of COVID-19 confirmed cases (social and household settings) by COVID-19 vaccination status of the index case and the close contact, from April to November 2021 in Navarre, Spain. The effects of vaccination of the index case and the close contact were estimated as (1-adjusted relative risk) × 100%. RESULTS Among 19,631 social contacts, 3257 (17%) were confirmed with SARS-CoV-2. COVID-19 vaccination of the index case reduced infectiousness by 44% (95% CI, 27-57%), vaccination of the close contact reduced susceptibility by 69% (95% CI, 65-73%), and vaccination of both reduced transmissibility by 74% (95% CI, 70-78%) in social settings, suggesting some synergy of effects. Among 20,708 household contacts, 6269 (30%) were infected, and vaccine effectiveness estimates were 13% (95% CI, -5% to 28%), 61% (95% CI, 58-64%), and 52% (95% CI, 47-56%), respectively. These estimates were lower in older people and had not relevant differences between the Alpha (April-June) and Delta (July-November) variant periods. CONCLUSIONS COVID-19 vaccination reduces infectiousness and susceptibility; however, these effects are insufficient for complete control of SARS-CoV-2 transmission, especially in older people and household setting. Relaxation of preventive behaviors after vaccination may counteract part of the vaccine effect on transmission.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain,CIBER Epidemiología y Salud Pública, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ana Miqueleiz
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Clinical Microbiology Department, Hospital Universitario de Navarra, Irunlarrea, 31008 Pamplona, Spain
| | - Nerea Egüés
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain,CIBER Epidemiología y Salud Pública, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain,CIBER Epidemiología y Salud Pública, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain,CIBER Epidemiología y Salud Pública, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Ana Navascués
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Clinical Microbiology Department, Hospital Universitario de Navarra, Irunlarrea, 31008 Pamplona, Spain
| | - Miguel Fernández-Huerta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Clinical Microbiology Department, Hospital Universitario de Navarra, Irunlarrea, 31008 Pamplona, Spain
| | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain,CIBER Epidemiología y Salud Pública, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain,CIBER Epidemiología y Salud Pública, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain,CIBER Epidemiología y Salud Pública, Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Carmen Ezpeleta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Clinical Microbiology Department, Hospital Universitario de Navarra, Irunlarrea, 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Leyre 15, 31003 Pamplona, Spain; CIBER Epidemiología y Salud Pública, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
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25
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Castilla J, García Cenoz M, Abad R, Sánchez-Cambronero L, Lorusso N, Izquierdo C, Cañellas Llabrés S, Roig J, Malvar A, González Carril F, Boone ALD, Pérez Martín J, Rodríguez Recio MJ, Galmés A, Caballero A, García Rojas A, Juanas F, Nieto M, Viloria Raymundo LJ, Martínez Ochoa E, Rivas AI, Castrillejo D, Moreno Pérez D, Martínez A, Borràs E, Sánchez Gómez A, Pastor E, Nartallo V, Arteagoitia JM, Álvarez-Fernández B, García Pina R, Fernández Arribas S, Vanrell J, García Hernández S, Mendoza RM, Méndez M, López-Tercero MM, Fernández-Rodríguez Á, Blanco Á, Carrillo de Albornoz FJ, Ruiz Olivares J, Ruiz-Montero R, Limia A, Navarro-Alonso JA, Vázquez JA, Barricarte A. Effectiveness of a Meningococcal Group B Vaccine (4CMenB) in Children. N Engl J Med 2023; 388:427-438. [PMID: 36724329 DOI: 10.1056/nejmoa2206433] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND In September 2015, the four-component, protein-based meningococcal serogroup B vaccine (4CMenB; Bexsero) became available for private purchase in Spain. METHODS We conducted a nationwide matched case-control study to assess the effectiveness of 4CMenB in preventing invasive meningococcal disease in children. The study included all laboratory-confirmed cases of invasive meningococcal disease in children younger than 60 months of age between October 5, 2015, and October 6, 2019, in Spain. Each case patient was matched with four controls according to date of birth and province. 4CMenB vaccination status of the case patients and controls was compared with the use of multivariate conditional logistic regression. RESULTS We compared 306 case patients (243 [79.4%] with serogroup B disease) with 1224 controls. A total of 35 case patients (11.4%) and 298 controls (24.3%) had received at least one dose of 4CMenB. The effectiveness of complete vaccination with 4CMenB (defined as receipt of at least 2 doses, administered in accordance with the manufacturer's recommendations) was 76% (95% confidence interval [CI], 57 to 87) against invasive meningococcal disease caused by any serogroup, and partial vaccination was 54% (95% CI, 18 to 74) effective. Complete vaccination resulted in an effectiveness of 71% (95% CI, 45 to 85) against meningococcal serogroup B disease. Vaccine effectiveness with at least one dose of 4CMenB was 64% (95% CI, 41 to 78) against serogroup B disease and 82% (95% CI, 21 to 96) against non-serogroup B disease. With the use of the genetic Meningococcal Antigen Typing System, serogroup B strains that were expected to be covered by 4CMenB were detected in 44 case patients, none of whom had been vaccinated. CONCLUSIONS Complete vaccination with 4CMenB was found to be effective in preventing invasive disease by serogroup B and non-serogroup B meningococci in children younger than 5 years of age.
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Affiliation(s)
- Jesús Castilla
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Manuel García Cenoz
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Raquel Abad
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Laura Sánchez-Cambronero
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Nicola Lorusso
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Conchita Izquierdo
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Soledad Cañellas Llabrés
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Javier Roig
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Alberto Malvar
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Fernando González Carril
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - An L D Boone
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Jaime Pérez Martín
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - M Jesús Rodríguez Recio
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Antònia Galmés
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Arturo Caballero
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Amós García Rojas
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Felipe Juanas
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Mercedes Nieto
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Luis J Viloria Raymundo
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Eva Martínez Ochoa
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Ana I Rivas
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Daniel Castrillejo
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - David Moreno Pérez
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Ana Martínez
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Eva Borràs
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Amaya Sánchez Gómez
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Eliseo Pastor
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Victoria Nartallo
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - José M Arteagoitia
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Blanca Álvarez-Fernández
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Rocío García Pina
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Socorro Fernández Arribas
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Joana Vanrell
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Sara García Hernández
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Rita M Mendoza
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Manuel Méndez
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - M Mar López-Tercero
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Ángela Fernández-Rodríguez
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Ángela Blanco
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - F Javier Carrillo de Albornoz
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - José Ruiz Olivares
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Rafael Ruiz-Montero
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Aurora Limia
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - José A Navarro-Alonso
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Julio A Vázquez
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
| | - Aurelio Barricarte
- From Instituto de Salud Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona (J.C., M.G.C., A.B.), Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (J.C., M.G.C., C.I., A.M., R.G.P., E.B., A.B.), Ministerio de Sanidad (L.S.-C., A.L., J.A.N.-A.), and Dirección General de Salud Pública, Comunidad de Madrid (S.C.L., A.S.-G.), Madrid, National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda (R.A., J.A.V.), Dirección General de Salud Pública y Ordenación Farmacéutica de Andalucía, Sevilla (N.L., D.M.P.), Agència de Salut Pública de Catalunya, Barcelona (C.I., A.M., E.B.), Dirección General de Salud Pública y Adicciones de la Comunidad Valenciana, Valencia (J.R., E.P.), Dirección Xeral da Saúde Pública da Galícia, Santiago de Compostela (A.M., V.N.), Dirección de Salud Pública y Adicciones del Gobierno Vasco, Vitoria (F.G.C., J.M.A.), Servicio de Vigilancia Epidemiológica de Asturias, Oviedo (A.L.D.B., B.A.-F.), Dirección General de Salud Pública y Adicciones, Instituto Murciano de Investigación Biosanitaria-Arrixaca, Murcia (J.P.M., R.G.P.), Servicio de Epidemiología de Castilla y León, Valladolid (M.J.R.R., S.F.A.), Direcció General de Salut Pública i Participació, Illes Balears, Palma de Mallorca (A.G., J.V.), Servicio Epidemiología de Castilla-La Mancha, Toledo (A.C., S.G.H.), Dirección General de Salud Pública de Canarias, Santa Cruz de Tenerife (A.G.R., R.M.M.), Dirección General de Salud Pública de Aragón, Zaragoza (F.J., M.M.), Dirección General de Salud Pública de Extremadura, Mérida (M.N., M.M.L.-T.), Dirección General de Salud Pública de Cantabria, Santander (L.J.V.R., A.F.-R.), Dirección General de Salud Pública, Consumo y Cuidados de La Rioja, Logroño (E.M.O., A.B.), Consejería de Sanidad, Consumo y Gobernación, Ceuta (A.I.R., F.J.C.A.), Dirección General de Salud Pública y Consumo, Melilla (D.C., J.R.O.), and Instituto Maimónides de Investigación Biomédica de Córdoba, Reina Sofia University Hospital, University of Cordoba, Cordoba (R.R.-M.) - all in Spain
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Martínez-Baz I, Trobajo-Sanmartín C, Miqueleiz A, Casado I, Navascués A, Burgui C, Ezpeleta C, Castilla J, Guevara M. Risk reduction of hospitalisation and severe disease in vaccinated COVID-19 cases during the SARS-CoV-2 variant Omicron BA.1-predominant period, Navarre, Spain, January to March 2022. Euro Surveill 2023; 28:2200337. [PMID: 36729113 PMCID: PMC9896606 DOI: 10.2807/1560-7917.es.2023.28.5.2200337] [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] [Indexed: 02/03/2023] Open
Abstract
BackgroundAs COVID-19 vaccine effectiveness against SARS-CoV-2 infection was lower for cases of the Omicron vs the Delta variant, understanding the effect of vaccination in reducing risk of hospitalisation and severe disease among COVID-19 cases is crucial.AimTo evaluate risk reduction of hospitalisation and severe disease in vaccinated COVID-19 cases during the Omicron BA.1-predominant period in Navarre, Spain.MethodsA case-to-case comparison included COVID-19 epidemiological surveillance data in adults ≥ 18 years from 3 January-20 March 2022. COVID-19 vaccination status was compared between hospitalised and non-hospitalised cases, and between severe (intensive care unit admission or death) and non-severe cases using logistic regression models.ResultsAmong 58,952 COVID-19 cases, 565 (1.0%) were hospitalised and 156 (0.3%) were severe. The risk of hospitalisation was reduced within the first 6 months after full COVID-19 vaccination (complete primary series) (adjusted odds ratio (aOR): 0.06; 95% CI: 0.04-0.09) and after 6 months (aOR: 0.16; 95% CI: 0.12-0.21; pcomparison < 0.001), as well as after a booster dose (aOR: 0.06: 95% CI: 0.04-0.07). Similarly, the risk of severe disease was reduced (aOR: 0.13, 0.18, and 0.06, respectively). Compared with cases fully vaccinated 6 months or more before a positive test, those who had received a booster dose had lower risk of hospitalisation (aOR: 0.38; 95% CI: 0.28-0.52) and severe disease (aOR: 0.38; 95% CI: 0.21-0.68).ConclusionsFull COVID-19 vaccination greatly reduced the risk of hospitalisation and severe outcomes in COVID-19 cases with the Omicron variant, and a booster dose improved this effect in people aged over 65 years.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, Pamplona, Spain,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ana Miqueleiz
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Pamplona, Spain,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ana Navascués
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Carmen Ezpeleta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, Pamplona, Spain,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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Trobajo-Sanmartín C, Miqueleiz A, Guevara M, Fernández-Huerta M, Burgui C, Casado I, Baigorria F, Navascués A, Ezpeleta C, Castilla J. Comparison of the Risk of Hospitalization and Severe Disease Among Co-circulating Severe Acute Respiratory Syndrome Coronavirus 2 Variants. J Infect Dis 2023; 227:332-338. [PMID: 36179126 DOI: 10.1093/infdis/jiac385] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 07/01/2022] [Accepted: 09/18/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We compare the risk of coronavirus disease 2019 (COVID-19) outcomes among co-circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants between January 2021 and May 2022 in Navarra, Spain. METHODS We compared the frequency of hospitalization and severe disease (intensive care unit admission or death) due to COVID-19 among the co-circulating variants. Variants analyzed were nonvariants of concern (non-VOCs), Alpha, Delta, Omicron BA.1, and Omicron BA.2. Logistic regression models were used to estimate adjusted odds ratio (aOR). RESULTS The Alpha variant had a higher risk of hospitalization (aOR, 1.86 [95 confidence interval {CI}, 1.282.71]) and severe disease (aOR, 2.40 [95 CI, 1.314.40]) than non-VOCs. The Delta variant did not show a significantly different risk of hospitalization (aOR, 0.73 [95 CI, .401.30]) and severe disease (aOR, 3.04 [95 CI, .5716.22]) compared to the Alpha variant. The Omicron BA.1 significantly reduced both risks relative to the Delta variant (aORs, 0.28 [95 CI, .16.47] and 0.23 [95 CI, .12.46], respectively). The Omicron BA.2 reduced the risk of hospitalization compared to BA.1 (aOR, 0.52 [95 CI, .29.95]). CONCLUSIONS The Alpha and Delta variants showed an increased risk of hospitalization and severe disease, which decreased considerably with the Omicron BA.1 and BA.2. Surveillance of variants can lead to important differences in severity.
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Affiliation(s)
- Camino Trobajo-Sanmartín
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Ana Miqueleiz
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Miguel Fernández-Huerta
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | | | - Ana Navascués
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Carmen Ezpeleta
- Navarra Institute for Health Research, Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pblica de Navarra, Pamplona, Spain
- CIBER Epidemiologa y Salud Pblica, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
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Kissling E, Pozo F, Martínez‐Baz I, Buda S, Vilcu A, Domegan L, Mazagatos C, Dijkstra F, Latorre‐Margalef N, Kurečić Filipović S, Machado A, Lazar M, Casado I, Dürrwald R, van der Werf S, O'Donnell J, Linares Dopido JA, Meijer A, Riess M, Višekruna Vučina V, Rodrigues AP, Mihai ME, Castilla J, Goerlitz L, Falchi A, Connell J, Castrillejo D, Hooiveld M, Carnahan A, Ilić M, Guiomar R, Ivanciuc A, Maurel M, Omokanye A, Valenciano M. Influenza vaccine effectiveness against influenza A subtypes in Europe: Results from the 2021-2022 I-MOVE primary care multicentre study. Influenza Other Respir Viruses 2022; 17:e13069. [PMID: 36702797 PMCID: PMC9835407 DOI: 10.1111/irv.13069] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 10/20/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In 2021-2022, influenza A viruses dominated in Europe. The I-MOVE primary care network conducted a multicentre test-negative study to measure influenza vaccine effectiveness (VE). METHODS Primary care practitioners collected information on patients presenting with acute respiratory infection. Cases were influenza A(H3N2) or A(H1N1)pdm09 RT-PCR positive, and controls were influenza virus negative. We calculated VE using logistic regression, adjusting for study site, age, sex, onset date, and presence of chronic conditions. RESULTS Between week 40 2021 and week 20 2022, we included over 11 000 patients of whom 253 and 1595 were positive for influenza A(H1N1)pdm09 and A(H3N2), respectively. Overall VE against influenza A(H1N1)pdm09 was 75% (95% CI: 43-89) and 81% (95% CI: 45-93) among those aged 15-64 years. Overall VE against influenza A(H3N2) was 29% (95% CI: 12-42) and 25% (95% CI: -41 to 61), 33% (95% CI: 14-49), and 26% (95% CI: -22 to 55) among those aged 0-14, 15-64, and over 65 years, respectively. The A(H3N2) VE among the influenza vaccination target group was 20% (95% CI: -6 to 39). All 53 sequenced A(H1N1)pdm09 viruses belonged to clade 6B.1A.5a.1. Among 410 sequenced influenza A(H3N2) viruses, all but eight belonged to clade 3C.2a1b.2a.2. DISCUSSION Despite antigenic mismatch between vaccine and circulating strains for influenza A(H3N2) and A(H1N1)pdm09, 2021-2022 VE estimates against circulating influenza A(H1N1)pdm09 were the highest within the I-MOVE network since the 2009 influenza pandemic. VE against A(H3N2) was lower than A(H1N1)pdm09, but at least one in five individuals vaccinated against influenza were protected against presentation to primary care with laboratory-confirmed influenza.
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Affiliation(s)
| | - Francisco Pozo
- National Centre for MicrobiologyInstitute of Health Carlos IIIMadridSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Iván Martínez‐Baz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | - Ana‐Maria Vilcu
- INSERM, Sorbonne UniversitéInstitut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136)ParisFrance
| | - Lisa Domegan
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,National Centre for EpidemiologyInstitute of Health Carlos IIIMadridSpain
| | - Frederika Dijkstra
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | | | - Mihaela Lazar
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Itziar Casado
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | - Sylvie van der Werf
- Unité de Génétique Moléculaire des Virus à ARN, Institut PasteurUniversité Paris Cité, UMR 3569 CNRSParisFrance,CNR virus des infections respiratoires, Institut PasteurParisFrance
| | - Joan O'Donnell
- Health Service Executive‐Health Protection Surveillance CentreDublinIreland
| | - Juan Antonio Linares Dopido
- Subdirección de Epidemiología, Dirección General de Salud Pública, Servicio Extremeño de SaludExtremaduraSpain
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | | | - Maria Elena Mihai
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain,Instituto de Salud Pública de Navarra ‐ IdiSNAPamplonaSpain
| | | | | | - Jeff Connell
- National Virus Reference LaboratoryUniversity College DublinDublinIreland
| | - Daniel Castrillejo
- Servicio de Epidemiología, DGSP, Consejería de Políticas Sociales, Salud Pública y Bienestar Animal, Ciudad Autónoma de MelillaMelillaSpain
| | | | | | - Maja Ilić
- Croatian Institute of Public HealthZagrebCroatia
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo JorgeLisbonPortugal
| | - Alina Ivanciuc
- “Cantacuzino” National Military Medical Institute for Research and DevelopmentBucharestRomania
| | | | - Ajibola Omokanye
- European Centre for Disease Prevention and ControlStockholmSweden
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29
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Pham TT, Nimptsch K, Aleksandrova K, Jenab M, Reichmann R, Wu K, Tjønneland A, Kyrø C, Schulze MB, Kaaks R, Katzke V, Palli D, Pasanisi F, Ricceri F, Tumino R, Krogh V, Roodhart J, Castilla J, Sánchez MJ, Colorado-Yohar SM, Harbs J, Rutegård M, Papier K, Aglago EK, Dimou N, Mayen-Chacon AL, Weiderpass E, Pischon T. Pre-Diagnostic Circulating Resistin Concentrations Are Not Associated with Colorectal Cancer Risk in the European Prospective Investigation into Cancer and Nutrition Study. Cancers (Basel) 2022; 14:5499. [PMID: 36428592 PMCID: PMC9688251 DOI: 10.3390/cancers14225499] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/12/2022] Open
Abstract
Resistin is a polypeptide implicated in inflammatory processes, and as such could be linked to colorectal carcinogenesis. In case-control studies, higher resistin levels have been found in colorectal cancer (CRC) patients compared to healthy individuals. However, evidence for the association between pre-diagnostic resistin and CRC risk is scarce. We investigated pre-diagnostic resistin concentrations and CRC risk within the European Prospective Investigation into Cancer and Nutrition using a nested case-control study among 1293 incident CRC-diagnosed cases and 1293 incidence density-matched controls. Conditional logistic regression models controlled for matching factors (age, sex, study center, fasting status, and women-related factors in women) and potential confounders (education, dietary and lifestyle factors, body mass index (BMI), BMI-adjusted waist circumference residuals) were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for CRC. Higher circulating resistin concentrations were not associated with CRC (RR per doubling resistin, 1.11; 95% CI 0.94-1.30; p = 0.22). There were also no associations with CRC subgroups defined by tumor subsite or sex. However, resistin was marginally associated with a higher CRC risk among participants followed-up maximally two years, but not among those followed-up after more than two years. We observed no substantial correlation between baseline circulating resistin concentrations and adiposity measures (BMI, waist circumference), adipokines (adiponectin, leptin), or metabolic and inflammatory biomarkers (C-reactive protein, C-peptide, high-density lipoprotein cholesterol, reactive oxygen metabolites) among controls. In this large-scale prospective cohort, there was little evidence of an association between baseline circulating resistin concentrations and CRC risk in European men and women.
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Affiliation(s)
- Thu-Thi Pham
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Katharina Nimptsch
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
| | - Krasimira Aleksandrova
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, 28359 Bremen, Germany
| | - Mazda Jenab
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), World Health Organization, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France
| | - Robin Reichmann
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Anne Tjønneland
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, 2100 Copenhagen, Denmark
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Verena Katzke
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy
| | - Fabrizio Pasanisi
- Dipartimento di Medicina Clinica E Chirurgia, Federico Ii University, 80131 Naples, Italy
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, 10095 Grugliasco, Italy
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research, AIRE ONLUS, 97100 Ragusa, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133 Milan, Italy
| | - Jeanine Roodhart
- Department of Medical Oncology, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jesús Castilla
- Navarra Public Health Institute—IdiSNA, 31003 Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Maria-Jose Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Sandra Milena Colorado-Yohar
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín 050010, Colombia
| | - Justin Harbs
- Department of Radiation Sciences, Oncology, Umeå University, SE-901 87 Umeå, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 87 Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, SE-901 87 Umeå, Sweden
| | - Keren Papier
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Elom K. Aglago
- Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK
| | - Niki Dimou
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), World Health Organization, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France
| | - Ana-Lucia Mayen-Chacon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), World Health Organization, 150 Cours Albert Thomas, CEDEX 08, 69372 Lyon, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, 13125 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Core Facility Biobank, 13125 Berlin, Germany
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30
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Burgui C, San Miguel R, Goñi-Esarte S, Juanbeltz R, Úriz-Otano JI, Reparaz J, Sarobe M, Zozaya JM, Castilla J. Effectiveness of hepatitis C antiviral treatment and feasibility of hepatitis C elimination goal. Postgrad Med 2022; 135:352-360. [PMID: 36305320 DOI: 10.1080/00325481.2022.2141499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Second-generation direct-acting antivirals (DAAs) have shown high efficacy in the treatment of chronic hepatitis C virus (HCV) infections in clinical trials. This study aimed to estimate the effectiveness in real-life conditions and their capacity to eliminate HCV infection in the general population. METHODS In this observational cohort study, patients with active HCV infection who commenced DAA treatment between 2015 and 2020 in Navarre, Spain, were studied. Sustained virological response (SVR), defined as an undetectable viral load 12 weeks after the end of treatment, was evaluated until the end of 2021. RESULTS Of a total 1366 HCV-infected patients that commenced treatment, 19.3% (n = 263) were HIV-coinfected. After the first DAA treatment, SVR was achieved in 96.6% (n = 1320/1366) of patients and in 97.7% (95% confidence interval [CI] 96.6%-98.3%) of those who completed treatment (per-protocol analysis; n = 1320/1351). SVR was achieved in 97.9% (n = 1066/1089) and 96.9% (n = 254/262) of mono-infected and HIV-coinfected patients, respectively. Thirty-one patients had virological failure due to non-response (n = 19), poor compliance (n = 9), and with adverse events (n = 3). Of 27 patients that received a second treatment, 24 attained SVR (one after a third treatment), two died, and one that did not achieve SVR declined a third treatment. Three patients were re-infected, re-treated, and achieved SVR. At the end of the study, 1344 patients (98.4%, 95% CI 97.6%-98.9%) had achieved SVR, and only 1.8% needed more than one course of treatment. All patients who completed the treatment and were followed-up achieved SVR. CONCLUSION With DAAs, SVR was achieved in all patients with active HCV infection who completed follow-up, and a second course of treatment was only necessary in a small proportion of patients. Adherence to treatment is essential for HCV infection elimination.
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Affiliation(s)
- Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ramón San Miguel
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - Silvia Goñi-Esarte
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Regina Juanbeltz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - Juan Isidro Úriz-Otano
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Reparaz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Medicina Interna, Hospital Universitario de Navarra, Pamplona, Spain
| | - Maite Sarobe
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Farmacia Hospitalaria, Hospital Universitario de Navarra, Pamplona, Spain
| | - José Manuel Zozaya
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Servicio de Digestivo, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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31
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Álvaro Varela AI, Aguinaga Pérez A, Navascués Ortega A, Castilla J, Ezpeleta Baquedano C. Clinical characteristics of patients with Mycoplasma pneumoniae infection. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:449-452. [PMID: 36154990 DOI: 10.1016/j.eimce.2022.08.002] [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: 05/04/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe the characteristics of patients diagnosed with Mycoplasma pneumoniae infection. METHODS A retrospective study of clinical and epidemiological characteristics of acute infections by M. pneumoniae confirmed by PCR was carried out in the Navarra Health Service (Spain) in 2014-2018. RESULTS M. pneumoniae infection was confirmed in 9.5% of analyzed patients. Among 123 confirmed cases, 65% were 5-14 years old, 21.1% <5 years old, and 13.8% were ≥14 years old. Pneumonia was radiologically confirmed in 83.7% of cases, and 22.0% presented extra-respiratory manifestations. A total of 44.7% of cases required hospitalization. Bilateral pneumonia, asthmatic crisis and extra-respiratory manifestations were associated to higher risk of hospitalization (81.3, 72.2 and 66.7%, respectively). Microbiological targeted treatment was monotherapy with macrolides in 60.2% of cases and combined with other antibiotics in 13.0%. CONCLUSION M. pneumoniae was the cause of acute respiratory infection affecting mainly to children younger than 14 years old and frequently required hospitalization.
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Affiliation(s)
| | - Aitziber Aguinaga Pérez
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Ana Navascués Ortega
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER, Epidemiologia y Salud Pública (CIBERESP)
| | - Carmen Ezpeleta Baquedano
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain
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32
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Claeys L, De Saeger S, Scelo G, Biessy C, Casagrande C, Nicolas G, Korenjak M, Fervers B, Heath AK, Krogh V, Luján-Barroso L, Castilla J, Ljungberg B, Rodriguez-Barranco M, Ericson U, Santiuste C, Catalano A, Overvad K, Brustad M, Gunter MJ, Zavadil J, De Boevre M, Huybrechts I. Mycotoxin Exposure and Renal Cell Carcinoma Risk: An Association Study in the EPIC European Cohort. Nutrients 2022; 14:3581. [PMID: 36079840 PMCID: PMC9460795 DOI: 10.3390/nu14173581] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mycotoxins have been suggested to contribute to a spectrum of adverse health effects in humans, including at low concentrations. The recognition of these food contaminants being carcinogenic, as co-occurring rather than as singularly present, has emerged from recent research. The aim of this study was to assess the potential associations of single and multiple mycotoxin exposures with renal cell carcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. METHODS Food questionnaire data from the EPIC cohort were matched to mycotoxin food occurrence data compiled by the European Food Safety Authority (EFSA) from European Member States to assess long-term dietary mycotoxin exposures, and to associate these with the risk of renal cell carcinoma (RCC, n = 911 cases) in 450,112 EPIC participants. Potential confounding factors were taken into account. Analyses were conducted using Cox's proportional hazards regression models to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) with mycotoxin exposures expressed as µg/kg body weight/day. RESULTS Demographic characteristics differed between the RCC cases and non-cases for body mass index, age, alcohol intake at recruitment, and other dietary factors. In addition, the mycotoxin exposure distributions showed that a large proportion of the EPIC population was exposed to some of the main mycotoxins present in European foods such as deoxynivalenol (DON) and derivatives, fumonisins, Fusarium toxins, Alternaria toxins, and total mycotoxins. Nevertheless, no statistically significant associations were observed between the studied mycotoxins and mycotoxin groups, and the risk of RCC development. CONCLUSIONS These results show an absence of statistically significant associations between long-term dietary mycotoxin exposures and RCC risk. However, these results need to be validated in other cohorts and preferably using repeated dietary exposure measurements. In addition, more occurrence data of, e.g., citrinin and fumonisins in different food commodities and countries in the EFSA database are a prerequisite to establish a greater degree of certainty.
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Affiliation(s)
- Liesel Claeys
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Sarah De Saeger
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium
- Department of Biotechnology and Food Technology, Faculty of Science, University of Johannesburg, Doornfontein Campus, Johannesburg 2092, South Africa
| | - Ghislaine Scelo
- Genomic Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Corinne Casagrande
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Genevieve Nicolas
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Michael Korenjak
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Beatrice Fervers
- Department Prevention Cancer Environment, Centre Léon Bérard, U1296 INSERM Radiation, Defense, Health and Environment, 28 Rue Laënnec, 69373 Lyon, France
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto dei Tumori di Milano, 1 Via Venezian, 20133 Milan, Italy
| | - Leila Luján-Barroso
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology—IDIBELL, Granvia de L-Hospitalet 199-203, 08908 L’Hospitalet de Llobregat, Spain
| | - Jesús Castilla
- Navarra Public Health Institute—IdiSNA, Leyre 15, 31003 Pamplona, Spain
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), C. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, SE-901 87 Umeå, Sweden
| | - Miguel Rodriguez-Barranco
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), C. Monforte de Lemos 3-5, 28029 Madrid, Spain
- Andalusian School of Public Health (EASP), 4 Cta. del Observatorio, 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, 15 Av. de Madrid, 18012 Granada, Spain
| | - Ulrika Ericson
- Department of Clinical Sciences in Malmö, Lund University, Jan Waldenströms gata 35, SE-214 28 Malmö, Sweden
| | - Carmen Santiuste
- Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), C. Monforte de Lemos 3-5, 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Heath Council, IMIB-Arrixaca, 11 Ronda de Levante, 30008 Murcia, Spain
| | - Alberto Catalano
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10143 Orbassano, Italy
| | - Kim Overvad
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark
| | - Magritt Brustad
- Department of Community Medicine, The Arctic University of Norway, Hansines veg 18, 9019 Tromsø, Norway
| | - Marc J. Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Jiri Zavadil
- Epigenomics and Mechanisms Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
| | - Marthe De Boevre
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), 9000 Ghent, Belgium
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 150 Cours Albert Thomas, 69008 Lyon, France
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Castilla J, Lecea Ó, Martín Salas C, Quílez D, Miqueleiz A, Trobajo-Sanmartín C, Navascués A, Martínez-Baz I, Casado I, Burgui C, Egüés N, Ezpeleta G, Ezpeleta C. Seroprevalence of antibodies against SARS-CoV-2 and risk of COVID-19 in Navarre, Spain, May to July 2022. Euro Surveill 2022; 27:2200619. [PMID: 35983774 PMCID: PMC9389855 DOI: 10.2807/1560-7917.es.2022.27.33.2200619] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 07/29/2022] [Accepted: 08/18/2022] [Indexed: 06/08/2023] Open
Abstract
In Navarre, Spain, in May 2022, the seroprevalence of anti-nucleocapsid (N) and anti-spike (S) antibodies of SARS-CoV-2 was 58.9% and 92.7%, respectively. The incidence of confirmed COVID-19 thereafter through July was lower in people with anti-N antibodies (adjusted odds ratio (aOR) = 0.08; 95% confidence interval (CI): 0.05-0.13) but not with anti-S antibodies (aOR = 1.06; 95% CI: 0.47-2.38). Hybrid immunity, including anti-N antibodies induced by natural exposure to SARS-CoV-2, seems essential in preventing Omicron COVID-19 cases.
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Affiliation(s)
- Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Óscar Lecea
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Carmen Martín Salas
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Ana Miqueleiz
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ana Navascués
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Nerea Egüés
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Carmen Ezpeleta
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
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Godoy P, Castilla J, Astray J, Godoy S, Tuells J, Barrabeig I, Domínguez Á. [Towards COVID-19 control through vaccination: obstacles, challenges and opportunities. SESPAS Report 2022]. Gac Sanit 2022; 36 Suppl 1:S82-S86. [PMID: 35781154 PMCID: PMC9244662 DOI: 10.1016/j.gaceta.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 01/09/2023]
Abstract
En España se inició el programa de vacunación en un contexto de alta transmisión y baja disponibilidad de vacunas. El objetivo de este artículo es revisar el programa de vacunación frente a la COVID-19 (3-3-2022) y valorar los obstáculos, los desafíos y las oportunidades que plantea el control de esta enfermedad. Se dispone actualmente de cinco vacunas: dos basadas en la tecnología ARNm (Comirnaty® y Spikevax®), dos basadas en un vector no replicativo (Vaxzevria® y Janssen) y una basada en la subunidad S (Novavax®). Las autoridades sanitarias han desarrollado estrategias de vacunación priorizando la prevención de hospitalizaciones y defunciones. En marzo de 2022 se superó el 90% de la población diana con vacunación completa y el 95% de cobertura en mayores de 50 años. El nuevo reto es conseguir coberturas similares para una tercera dosis. La vacunación en la infancia y la adolescencia se ha convertido en una prioridad por las implicaciones educativas y sociales que comporta la COVID-19. Se deberán renovar las estrategias comunicativas y eliminar las barreras de acceso para conseguir buenas coberturas. En España se han publicado estudios que muestran una alta efectividad de la vacunación. La principal estrategia para el control de la pandemia y para recuperar la actividad social es la vacunación, pero todo indica que serán necesarios niveles muy altos de cobertura vacunal y seguir con medidas no farmacológicas. En un mundo globalizado, el control de la COVID-19 solo se alcanzará con una estrategia global coordinada y el apoyo a la vacunación en los países con pocos recursos.
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Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España.
| | - Jesús Castilla
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, España
| | - Jenaro Astray
- Dirección General de Salud Pública, Subdirección General de Epidemiología, Comunidad de Madrid, Madrid, España
| | - Sofía Godoy
- Institut Català de la Salut (ICS), Lleida, España
| | - José Tuells
- Departamento de Salud Pública, Universidad de Alicante, Alicante, España
| | - Irene Barrabeig
- Agència de Salut Pública de Catalunya, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departament de Medicina, Universitat de Barcelona, Barcelona, España
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Sentís A, Kislaya I, Nicolay N, Meijerink H, Starrfelt J, Martínez-Baz I, Castilla J, Nielsen KF, Hansen CH, Emborg HD, Nardone A, Derrough T, Valenciano M, Nunes B, Monge S. Estimation of COVID-19 vaccine effectiveness against hospitalisation in individuals aged ≥ 65 years using electronic health registries; a pilot study in four EU/EEA countries, October 2021 to March 2022. Euro Surveill 2022; 27:2200551. [PMID: 35904059 PMCID: PMC9336167 DOI: 10.2807/1560-7917.es.2022.27.30.2200551] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/26/2022] Open
Abstract
By employing a common protocol and data from electronic health registries in Denmark, Navarre (Spain), Norway and Portugal, we estimated vaccine effectiveness (VE) against hospitalisation due to COVID-19 in individuals aged ≥ 65 years old, without previous documented infection, between October 2021 and March 2022. VE was higher in 65-79-year-olds compared with ≥ 80-year-olds and in those who received a booster compared with those who were primary vaccinated. VE remained high (ca 80%) between ≥ 12 and < 24 weeks after the first booster administration, and after Omicron became dominant.
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Affiliation(s)
| | - Irina Kislaya
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Nathalie Nicolay
- Vaccine preventable diseases and Immunisation, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | | | | | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,CIBER on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,CIBER on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | | | | | | | - Tarik Derrough
- Vaccine preventable diseases and Immunisation, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | | | - Baltazar Nunes
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | - Susana Monge
- Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,CIBER on Infectious Diseases (CIBERINFEC), Madrid, Spain
| | -
- Members of the VEBIS-Lot4 working group are listed under Collaborators
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36
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Martínez-Baz I, Casado I, Miqueleiz A, Navascués A, Pozo F, Trobajo-Sanmartín C, Albéniz E, Elía F, Burgui C, Fernández-Huerta M, Ezpeleta C, Castilla J. Effectiveness of influenza vaccination in preventing influenza in primary care, Navarre, Spain, 2021/22. Euro Surveill 2022; 27. [PMID: 35775428 PMCID: PMC9248265 DOI: 10.2807/1560-7917.es.2022.27.26.2200488] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Compared with individuals unvaccinated in the current and three previous influenza seasons, in 2021/22, influenza vaccine effectiveness at primary care level was 37% (95% CI: 16 to 52) for current season vaccination, regardless of previous doses, and 35% (95% CI: −3 to 45) for only previous seasons vaccination. Against influenza A(H3N2), estimates were 39% (95% CI: 16 to 55) and 24% (95% CI: −8 to 47) suggesting moderate effectiveness of current season vaccination and possible remaining effect of prior vaccinations.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Ana Miqueleiz
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Navascués
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Francisco Pozo
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Esther Albéniz
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Fernando Elía
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Miguel Fernández-Huerta
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Carmen Ezpeleta
- Navarre Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
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Kissling E, Hooiveld M, Martínez-Baz I, Mazagatos C, William N, Vilcu AM, Kooijman MN, Ilić M, Domegan L, Machado A, de Lusignan S, Lazar M, Meijer A, Brytting M, Casado I, Larrauri A, Murray JLK, Behillil S, de Gier B, Mlinarić I, O’Donnell J, Rodrigues AP, Tsang R, Timnea O, de Lange M, Riess M, Castilla J, Pozo F, Hamilton M, Falchi A, Knol MJ, Kurečić Filipović S, Dunford L, Guiomar R, Cogdale J, Cherciu C, Jansen T, Enkirch T, Basile L, Connell J, Gomez V, Sandonis Martín V, Bacci S, Rose AMC, Pastore Celentano L, Valenciano M. Effectiveness of complete primary vaccination against COVID-19 at primary care and community level during predominant Delta circulation in Europe: multicentre analysis, I-MOVE-COVID-19 and ECDC networks, July to August 2021. Euro Surveill 2022; 27:2101104. [PMID: 35620997 PMCID: PMC9137272 DOI: 10.2807/1560-7917.es.2022.27.21.2101104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/29/2022] Open
Abstract
IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe.AimUsing a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection.MethodsIndividuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-CoV-2. We measured complete primary course overall VE by vaccine brand and by time since vaccination.ResultsOverall VE was 74% (95% CI: 69-79), 76% (95% CI: 71-80), 63% (95% CI: 48-75) and 63% (95% CI: 16-83) among those aged 30-44, 45-59, 60-74 and ≥ 75 years, respectively. VE among those aged 30-59 years was 78% (95% CI: 75-81), 66% (95% CI: 58-73), 91% (95% CI: 87-94) and 52% (95% CI: 40-61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among people 60 years and older was 67% (95% CI: 52-77), 65% (95% CI: 48-76) and 83% (95% CI: 64-92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30-59 years was 87% (95% CI: 83-89) at 14-29 days and 65% (95% CI: 56-71%) at ≥ 90 days between vaccination and onset of symptoms.ConclusionsVE against symptomatic infection with the SARS-CoV-2 Delta variant varied among brands, ranging from 52% to 91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% at 90 days or more between vaccination and onset.
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Affiliation(s)
| | | | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Ana-Maria Vilcu
- INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Marjolein N Kooijman
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Maja Ilić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Ausenda Machado
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Mihaela Lazar
- “Cantacuzino” National Military Medical Institute for Research and Development, Bucharest, Romania
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mia Brytting
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Amparo Larrauri
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Sylvie Behillil
- Unité de Génétique Moléculaire des Virus à ARN, UMR 3569 CNRS, Université Paris Diderot SPC, Institut Pasteur, Paris, France,CNR des virus des infections respiratoires, Institut Pasteur, Paris, France
| | - Brechje de Gier
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ivan Mlinarić
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Joan O’Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Olivia Timnea
- “Cantacuzino” National Military Medical Institute for Research and Development, Bucharest, Romania
| | - Marit de Lange
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | | | | | - Mirjam J Knol
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Linda Dunford
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Carmen Cherciu
- “Cantacuzino” National Military Medical Institute for Research and Development, Bucharest, Romania
| | | | | | - Luca Basile
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain,Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública, Agencia de Salud Pública, Catalunya, Spain
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Verónica Gomez
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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38
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Burgui C, Guy D, Fresán U, Kall M, Castilla J, Lazarus JV. Patient satisfaction with HIV care service in Spain: results from a cross-sectional patient survey. AIDS Care 2022; 35:892-898. [PMID: 35102807 DOI: 10.1080/09540121.2022.2029818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Understanding patient satisfaction with healthcare services can help identify patients' unmet needs and increase treatment adherence. This study aimed to evaluate the satisfaction of people living with HIV with overall HIV care service in Navarra, Spain, using a cross-sectional survey. The survey included a patient-reported experience measure (PREMs) consisting of five statements, and participants were also asked to rate the overall care they receive from the HIV service. Chi-square tests were used to detect differences between groups for statements and Kruskal-Wallis rank test was used to detect differences in ranking of the HIV service. The 395 participants gave the HIV service a mean score of 9.3 points out of 10 (standard deviation 1.1). Only 15 (4%) gave a score of under 8 out of 10, and adherence to antiretroviral therapy was associated with higher ranking of the service. Agreement for all five statements ranged from 80% to 96%. Those without stable housing, with mental health problems, and unemployed felt less supported to manage their HIV. These results highlight the need to regularly assess patient satisfaction with the HIV care and that care should account for social and economic factors that could influence health.
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Affiliation(s)
- Cristina Burgui
- Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ujué Fresán
- Barcelona Institute for Global Health (ISGlobal), Campus Mar, University of Barcelona, Barcelona, Spain
| | - Meaghan Kall
- HIV/STI Department, Public Health England, London, UK
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, University of Barcelona, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Martínez-Baz I, Trobajo-Sanmartín C, Burgui C, Casado I, Castilla J. Transmission of SARS-CoV-2 infection and risk factors in a cohort of close contacts. Postgrad Med 2022; 134:230-238. [PMID: 35102793 DOI: 10.1080/00325481.2022.2037360] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/26/2022]
Abstract
PURPOSE Many factors might affect SARS-CoV-2 transmission, but their relevance is not well established. The objectives were to assess the secondary attack rate (SAR) and the risk factors for SARS-CoV-2 transmission from confirmed index cases to their close contacts in household and non-household settings. METHODS This cohort study included the close contacts of SARS-CoV-2 infected cases confirmed between May and December 2020 in Navarre, Spain. Epidemiological and clinical variables of the index case and close contacts were collected. The SAR was calculated, and the independent effect of each variable on the transmission risk was evaluated by logistic regression. RESULTS A total of 59,900 close contacts of 20,048 index cases were studied, and 53.6% were household contacts. SAR was 34.9% overall, 46.8% in household contacts and 21.1% in non-household contacts. The risk of transmission was higher in household setting (adjusted odds ratio (aOR) 2.96, 95% CI 2.84-3.07), from symptomatic index cases (aOR 1.50, 95% CI 1.43-1.58), immigrants (aOR 1.44, 95% CI 1.36-1.52), and increased with age. A higher susceptibility of close contacts was associated with 5-14 years of age, immigrants (aOR 1.54), very low or low-income level (aOR 1.27, and aOR, 1.17, respectively), healthcare work (aOR 1.21), and diagnosis of diabetes (aOR 1.14, 95%CI 1.03-1.25), chronic kidney disease (aOR 1.18, 95%CI 1.04-1.35), hypertension (aOR 1.11, 95% CI 1.03-1.19), and severe obesity (aOR 1.18, 95% CI 1.00-1.38). Transmission increased progressively from May to September 2020 as the B.1.177 variant became dominant. CONCLUSION The risk of SARS-CoV-2 infection was considerable among close contacts of infected persons. The higher risk associated with household contacts, immigrants, older index cases, close contacts with lower income level and comorbidities should be considered to address preventive interventions.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
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Domínguez A, Varela C, Soldevila N, Izquierdo C, Guerrero M, Peñuelas M, Martínez A, Godoy P, Borràs E, Rius C, Torner N, Avellón AM, Castilla J. Hepatitis A Outbreak Characteristics: A Comparison of Regions with Different Vaccination Strategies, Spain 2010-2018. Vaccines (Basel) 2021; 9:1214. [PMID: 34835145 PMCID: PMC8620672 DOI: 10.3390/vaccines9111214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 12/25/2022] Open
Abstract
We compared the cumulative incidence and characteristics of hepatitis A outbreaks in two groups of Spanish autonomous regions according to whether a universal or risk group vaccination strategy was followed. Outbreaks between 2010 and 2018 were analyzed. The cumulative incidence rate of outbreaks was estimated and compared by estimating the rate ratio (RR). The characteristics of the outbreaks and those of the first cases were compared. Adjusted OR (aOR) were calculated using a multivariate logistic regression model. Outbreak incidence was 16.04 per million persons in regions with universal vaccination and 20.76 in those with risk-group vaccination (RR 0.77; 95%CI 0.62-0.94). Imported outbreaks accounted for 65% in regions with universal vaccination and 28.7% in regions with risk-group vaccination (aOR 3.88; 95%CI 2.13-7.09). Adolescents and young adults aged 15-44 years and men who have sex with men were less frequently the first case of the outbreak in regions with a universal vaccination strategy (aOR 0.54; 95%CI 0.32-0.92 and 0.23; 95%CI 0.07-0.82, respectively). The cumulative incidence rate of outbreaks was lower in regions with universal vaccination. In all regions, independently of the vaccination strategy, activities to vaccinate persons belonging to high-risk groups for infection should be emphasized.
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Affiliation(s)
- Angela Domínguez
- Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | - Carmen Varela
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Núria Soldevila
- Department of Medicine, Universidad de Barcelona, 08036 Barcelona, Spain;
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | | | - María Guerrero
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Marina Peñuelas
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (M.G.); (M.P.)
| | - Ana Martínez
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Pere Godoy
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Eva Borràs
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Catalunya, 08005 Barcelona, Spain;
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Núria Torner
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
| | - Ana María Avellón
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28222 Madrid, Spain
| | - Jesús Castilla
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (C.V.); (A.M.); (P.G.); (E.B.); (C.R.); (N.T.); (A.M.A.); (J.C.)
- Instituto Salud Pública de Navarra-IdiSNA, 31003 Pamplona, Spain
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Martínez-Baz I, Trobajo-Sanmartín C, Miqueleiz A, Guevara M, Fernández-Huerta M, Burgui C, Casado I, Portillo ME, Navascués A, Ezpeleta C, Castilla J. Product-specific COVID-19 vaccine effectiveness against secondary infection in close contacts, Navarre, Spain, April to August 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34596016 PMCID: PMC8485582 DOI: 10.2807/1560-7917.es.2021.26.39.2100894] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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] [Indexed: 01/06/2023]
Abstract
COVID-19 vaccine effectiveness by product (two doses Comirnaty, Spikevax or Vaxzevria and one of Janssen), against infection ranged from 50% (95% CI: 42 to 57) for Janssen to 86% (70 to 93) for Vaxzevria-Comirnaty combination; among ≥ 60 year-olds, from 17% (−26 to 45) for Janssen to 68% (48 to 80) for Spikevax; and against hospitalisation from 74% (43 to 88) for Janssen to > 90% for other products. Two doses of vaccine were highly effective against hospitalisation, but suboptimal for infection control.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Miqueleiz
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Miguel Fernández-Huerta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - María Eugenia Portillo
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Navascués
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Carmen Ezpeleta
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.,Clinical Microbiology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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- Other members of the Working Group for the Study of COVID-19 in Navarre are listed in the Investigators tab
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Kall M, Fresán U, Guy D, Brown G, Burgui C, Castilla J, Grecu VI, Dumitrescu F, Delpech V, Lazarus JV. Quality of life in people living with HIV in Romania and Spain. BMC Infect Dis 2021; 21:898. [PMID: 34517820 PMCID: PMC8436864 DOI: 10.1186/s12879-021-06567-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 01/30/2023] Open
Abstract
Background Health-related quality of life (HRQoL) is a crucial component in assessing and addressing the unmet needs of people, especially those with chronic illnesses such as HIV. The aim of the study was to examine and compare the health-related quality of life of people living with HIV in Romania and Spain, compared to the general populations of each country. Methods A cross-sectional survey was conducted among adults (≥ 18 years) attending for HIV care in Romania and Spain from October 2019 to March 2020. The survey included two validated HRQoL instruments: a generic instrument, EQ-5D-5L, and an HIV-specific instrument, PozQoL, and questions on socio-demographics, HIV-related characteristics, physical and mental health conditions, and substance use. Multivariable linear regression was used to determine factors associated with HRQoL. Results 570 people living with HIV responded (170 in Romania and 400 in Spain). The median age was 31 (18–67) in Romania and 52 (19–83) in Spain. Anxiety/depression symptoms were frequently reported by people with HIV (Romania: 50% vs 30% in the Romanian population; Spain: 38% vs 15% in Spanish population). Spain reported higher mean EQ-5Dutility scores than Romania (0.88 and 0.85, respectively) but identical PozQoL scores (3.5, on a scale of 0–5). In both countries, health concerns were highlighted as a key issue for people with HIV. In multivariable analysis, two factors were consistently associated with worse HRQoL in people with HIV: bad or very bad self-rated health status and presence of a mental health condition. In Romania, being gay/bisexual and being disabled/unemployed were associated with worse HRQoL. Whereas in Spain, older age and financial insecurity were significant predictors. Conclusions Our results indicated a good HRQoL for people living with HIV in Romania and Spain; however, worse HRQoL profiles were characterized by health concerns, poor self-rated health status, and the presence of mental health conditions. This study highlights the importance of monitoring HRQoL in people living with HIV due to the chronic nature of the disease. In this highly-treatment experienced group, disparities were found, particularly highlighting mental health as an area which needs more attention to improve the well-being of people living with HIV.
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Affiliation(s)
- Meaghan Kall
- HIV/STI Department, Public Health England, London, NW9 5EQ, UK.
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra-IdiSNA-CIBERESP, Pamplona, Spain
| | - Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, S08036, Barcelona, Spain
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, High Street, Sydney, Australia
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA-CIBERESP, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA-CIBERESP, Pamplona, Spain
| | - Victor Ionel Grecu
- Spitalul Clinic de Boli Infectioase si Pneumoftiziologie "Victor Babes" Craiova, 200515, Craiova, Romania
| | - Florentina Dumitrescu
- Spitalul Clinic de Boli Infectioase si Pneumoftiziologie "Victor Babes" Craiova, 200515, Craiova, Romania
| | - Valerie Delpech
- HIV/STI Department, Public Health England, London, NW9 5EQ, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, S08036, Barcelona, Spain
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Godoy P, García-Cenoz M, Rius C, Muñoz-Almagro C, Carmona G, Alsedà M, Jané M, Vidal MJ, Rodríguez R, Álvarez J, Camps N, Minguell S, Carol M, Sala MR, Castilla J, Domínguez À. Effectiveness of maternal pertussis vaccination in protecting newborn: A matched case-control study. J Infect 2021; 83:554-558. [PMID: 34407422 DOI: 10.1016/j.jinf.2021.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/13/2019] [Revised: 02/15/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective was to estimate the effectiveness of maternal pertussis vaccination in protecting infants aged < 2 months. METHODS We performed a case-control study. Laboratory-confirmed cases aged <8 weeks at disease onset were identified and 2-4 matched-controls born within ± 15 days of the case were included. Information was obtained from healthcare providers and maternal interviews. Odds ratios (OR) were calculated using multivariable conditional logistic regression. Vaccine effectiveness (VE) was estimated as (1 - OR) × 100%. RESULTS 47 cases and 124 controls were studied. The mean age (in days) (39.8 ± 12.7 vs. 40.8 ± 13.2), weeks of gestation (38.8 vs. 39.1, p = 0.43) and mean birth weight (3.309 vs. 3.253 kg, p = 0.55) were comparable between cases and controls. Mothers of cases were less frequently vaccinated in the third trimester (59.6% vs. 83.9%, p <0.001). The VE of maternal vaccination in pregnancy was 88.0% (95%CI 53.8% -96.5%), and was slightly higher in those vaccinated before the 32nd week of gestation (88.5% vs 87.8%). CONCLUSION Pertussis vaccination in pregnancy is very effective in reducing pertussis in children aged < 2 months. Vaccination before and after the 32nd week of pregnancy are equally effective in reducing the risk of pertussis.
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Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Institut de Recerca Biomèdica de Lleida. IRBLleida. Lleida, Spain.
| | - Manuel García-Cenoz
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Instituto de Salud Pública de Navarra - idiSNA, Pamplona, Spain
| | - Cristina Rius
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Agència de Salut Pública de Barcelona. Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Institut de Recerca Pediàtrica, Hospital de Sant Joan de Dèu, Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya
| | | | - Miquel Alsedà
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Institut de Recerca Biomèdica de Lleida. IRBLleida. Lleida, Spain
| | - Mireia Jané
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain
| | | | | | - Josep Álvarez
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | - Neus Camps
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | | | - Mónica Carol
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | | | - Jesús Castilla
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Instituto de Salud Pública de Navarra - idiSNA, Pamplona, Spain
| | - Àngela Domínguez
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Departament de Medicina, Universitat de Barcelona. Barcelona, Spain
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Martínez-Baz I, Navascués A, Casado I, Aguinaga A, Ezpeleta C, Castilla J. Simple models to include influenza vaccination history when evaluating the effect of influenza vaccination. ACTA ACUST UNITED AC 2021; 26. [PMID: 34387185 PMCID: PMC8365179 DOI: 10.2807/1560-7917.es.2021.26.32.2001099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/20/2022]
Abstract
Background Most reports of influenza vaccine effectiveness consider current-season vaccination only. Aim We evaluated a method to estimate the effect of influenza vaccinations (EIV) considering vaccination history. Methods We used a test-negative design with well-documented vaccination history to evaluate the average EIV over eight influenza seasons (2011/12–2018/19; n = 10,356). Modifying effect was considered as difference in effects of vaccination in current and previous seasons and current-season vaccination only. We also explored differences between current-season estimates excluding from the reference category people vaccinated in any of the five previous seasons and estimates without this exclusion or only for one or three previous seasons. Results The EIV was 50%, 45% and 38% in people vaccinated in the current season who had previously received none, one to two and three to five doses, respectively, and it was 30% and 43% for one to two and three to five prior doses only. Vaccination in at least three previous seasons reduced the effect of current-season vaccination by 12 percentage points overall, 31 among outpatients, 22 in 9–65 year-olds, and 23 against influenza B. Including people vaccinated in previous seasons only in the unvaccinated category underestimated EIV by 9 percentage points on average (31% vs 40%). Estimates considering vaccination of three or five previous seasons were similar. Conclusions Vaccine effectiveness studies should consider influenza vaccination in previous seasons, as it can retain effect and is often an effect modifier. Vaccination status in three categories (current season, previous seasons only, unvaccinated) reflects the whole EIV.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Ana Navascués
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Itziar Casado
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Aitziber Aguinaga
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Carmen Ezpeleta
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Jesús Castilla
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.,Instituto de Salud Pública de Navarra, Pamplona, Spain
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45
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Kissling E, Hooiveld M, Sandonis Martín V, Martínez-Baz I, William N, Vilcu AM, Mazagatos C, Domegan L, de Lusignan S, Meijer A, Machado A, Brytting M, Casado I, Murray JLK, Belhillil S, Larrauri A, O'Donnell J, Tsang R, de Lange M, Rodrigues AP, Riess M, Castilla J, Hamilton M, Falchi A, Pozo F, Dunford L, Cogdale J, Jansen T, Guiomar R, Enkirch T, Burgui C, Sigerson D, Blanchon T, Martínez Ochoa EM, Connell J, Ellis J, van Gageldonk-Lafeber R, Kislaya I, Rose AM, Valenciano M. Vaccine effectiveness against symptomatic SARS-CoV-2 infection in adults aged 65 years and older in primary care: I-MOVE-COVID-19 project, Europe, December 2020 to May 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34296676 PMCID: PMC8299744 DOI: 10.2807/1560-7917.es.2021.26.29.2100670] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We measured COVID-19 vaccine effectiveness (VE) against symptomatic SARS-CoV-2 infection at primary care/outpatient level among adults ≥ 65 years old using a multicentre test-negative design in eight European countries. We included 592 SARS-CoV-2 cases and 4,372 test-negative controls in the main analysis. The VE was 62% (95% CI: 45–74) for one dose only and 89% (95% CI: 79–94) for complete vaccination. COVID-19 vaccines provide good protection against COVID-19 presentation at primary care/outpatient level, particularly among fully vaccinated individuals.
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Affiliation(s)
| | | | | | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Ana-Maria Vilcu
- INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Clara Mazagatos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Ausenda Machado
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Mia Brytting
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Itziar Casado
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Sylvie Belhillil
- Unité de Génétique Moléculaire des Virus à ARN, UMR 3569 CNRS, Université Paris Diderot SPC, Institut Pasteur, Paris, France.,CNR des virus des infections respiratoires, Institut Pasteur, Paris, France
| | - Amparo Larrauri
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Ruby Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Royal College of General Practitioners Research and Surveillance Centre, London, UK
| | - Marit de Lange
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Linda Dunford
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | | | - Raquel Guiomar
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Cristina Burgui
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | | | - Thierry Blanchon
- INSERM, Sorbonne Université, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Eva María Martínez Ochoa
- Servicio de Epidemiología y Prevención Sanitaria, Dirección General de Salud Pública, Consumo y Cuidados, La Rioja, Spain
| | - Jeff Connell
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | | | | | - Irina Kislaya
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
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- The members of the I-MOVE-COVID-19 primary care study team are listed in the Investigators tab
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Martínez-Baz I, Navascués A, Casado I, Portillo ME, Guevara M, Gómez-Ibáñez C, Burgui C, Ezpeleta C, Castilla J. Effect of influenza vaccination in patients with asthma. CMAJ 2021; 193:E1120-E1128. [PMID: 34312165 PMCID: PMC8321300 DOI: 10.1503/cmaj.201757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND: Although annual influenza vaccination is recommended for persons with asthma, its effectiveness in this patient population is not well described. We evaluated the effect of influenza vaccination in the current and previous seasons in preventing influenza among people with asthma. METHODS: Using population health data from the Navarre region of Spain for the 2015/16 to 2019/20 influenza seasons, we conducted a test-negative case–control study to assess the effect of influenza vaccination in the current and 5 previous seasons. From patients presenting to hospitals and primary health care centres with influenza-like illness who underwent testing for influenza, we estimated the effects of influenza vaccination among patients with asthma overall and between those presenting as inpatients or outpatients, as well as between patients with and without asthma. RESULTS: Of 1032 patients who had asthma and were tested, we confirmed that 421 had influenza and the remaining 611 were test-negative controls. We found that the average effect of influenza vaccination was 43% (adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.40 to 0.80) for current-season vaccination regardless of previous doses, and 38% (adjusted OR 0.62, 95% CI 0.39 to 0.96) for vaccination in previous seasons only. Effects were similar for outpatients and inpatients. Among patients with asthma and confirmed influenza, current-season vaccination did not reduce the odds of hospital admission (adjusted OR 1.05, 95% CI 0.51 to 2.18). Influenza vaccination effects were similar for patients with and without asthma. INTERPRETATION: We estimated that, on average, current or previous influenza vaccination of people with asthma prevented almost half of influenza cases. These results support recommendations that people with asthma receive influenza vaccination.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - Ana Navascués
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - María Eugenia Portillo
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - Carlos Gómez-Ibáñez
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - Carmen Ezpeleta
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA (Martínez-Baz, Casado, Guevara, Gómez-Ibáñez, Burgui, Castilla); Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra - IdiSNA (Navascués, Portillo, Ezpeleta), Pamplona, Spain; CIBER Epidemiología y Salud Pública, (Martínez-Baz, Casado, Guevara, Burgui, Castilla) Madrid, Spain.
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47
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Martínez-Baz I, Navascués A, Portillo ME, Casado I, Fresán U, Ezpeleta C, Castilla J. Effect of Influenza Vaccination in Preventing Laboratory-Confirmed Influenza Hospitalization in Patients With Diabetes Mellitus. Clin Infect Dis 2021; 73:107-114. [PMID: 32412600 DOI: 10.1093/cid/ciaa564] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/11/2020] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People with diabetes are at high risk of severe influenza complications. The influenza vaccination effect among diabetic patients remains inconclusive. We estimated the average effect of influenza vaccination status in the current and prior seasons in preventing laboratory-confirmed influenza hospitalization in diabetic patients. METHODS Patients attended in hospitals and primary healthcare centers with influenza-like illness were tested for influenza from the 2013-2014 to 2018-2019 seasons in Navarre, Spain. A test-negative case-control design in diabetic inpatients compared the influenza vaccination status in the current and 5 prior seasons between laboratory-confirmed influenza cases and negative controls. Vaccination status of influenza-confirmed cases was compared between diabetic inpatients and outpatients. Influenza vaccination effect was compared between diabetic patients and older (≥ 60 years) or chronic nondiabetic patients. RESULTS Of 1670 diabetic inpatients tested, 569 (34%) were confirmed for influenza and 1101 were test-negative controls. The average effect in preventing influenza hospitalization was 46% (95% confidence interval [CI], 28%-59%) for current-season vaccination and 44% (95% CI, 20%-61%) for vaccination in prior seasons only in comparison to unvaccinated patients in the current and prior seasons. Among diabetic patients with confirmed influenza, current-season vaccination reduced the probability of hospitalization (adjusted odds ratio, 0.35; 95% CI, .15-.79). In diabetic patients, vaccination effect against influenza hospitalizations was not inferior to that in older or chronic nondiabetic patients. CONCLUSIONS On average, influenza vaccination of diabetic population reduced by around half the risk of influenza hospitalization. Vaccination in prior seasons maintained a notable protective effect. These results reinforce the recommendation of influenza vaccination for diabetic patients.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Navascués
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - María Eugenia Portillo
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Ezpeleta
- Clinical Microbiology Department, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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48
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Guevara M, Salamanca-Fernández E, Miqueleiz E, Gavrila D, Amiano P, Bonet C, Rodríguez-Barranco M, Huerta JM, Bujanda L, Sánchez MJ, Chirlaque MD, Agudo A, Ardanaz E, Castilla J. Inflammatory Potential of the Diet and Incidence of Crohn's Disease and Ulcerative Colitis in the EPIC-Spain Cohort. Nutrients 2021; 13:nu13072201. [PMID: 34206846 PMCID: PMC8308349 DOI: 10.3390/nu13072201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/12/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Diet may influence the development of inflammatory bowel disease through the modulation of inflammation. We investigated whether the inflammatory potential of the diet is associated with the risk of Crohn’s disease (CD) and ulcerative colitis (UC) in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The study included 32,633 participants aged 29–69 years. The inflammatory potential of the diet was measured by using an inflammatory score of the diet (ISD) based on a baseline dietary history questionnaire. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 21 years (674,547 person-years) of follow-up, 32 and 57 participants developed CD and UC, respectively. In multivariable analysis, a one-standard deviation (SD) increment in the ISD (two-unit increase) was associated with a higher risk of CD (HR of 1.71; 95% CI: 1.05–2.80; p = 0.031). By contrast, ISD was not associated with UC (HR for one-SD increment of 0.89; 95% CI: 0.66–1.19; p = 0.436). Our results suggest that consuming a more pro-inflammatory diet may contribute to the risk of CD, supporting that a healthy diet might be beneficial in its prevention. Further, larger studies are needed to verify these findings.
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Affiliation(s)
- Marcela Guevara
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
- Correspondence:
| | | | - Estrella Miqueleiz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
| | - Diana Gavrila
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Sub-Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, 20013 San Sebastian, Spain
- Epidemiology and Public Health Area, Biodonostia Health Research Institute, 20014 San Sebastian, Spain
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Catalan Institute of Oncology—ICO, and Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L’Hospitalet de Llobregat, Spain; (C.B.); (A.A.)
| | - Miguel Rodríguez-Barranco
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Andalusian School of Public Health (EASP), 18011 Granada, Spain
| | - José María Huerta
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
| | - Luis Bujanda
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, 20014 San Sebastian, Spain;
- Department of Gastroenterology, University of the Basque Country (UPV/EHU), 20018 San Sebastian, Spain
- Consortium for Biomedical Research in Hepatic and Digestive Diseases, CIBEREHD, 28029 Madrid, Spain
| | - María José Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Andalusian School of Public Health (EASP), 18011 Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - María Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
- Departamento de Ciencias Sociosanitarias, Facultad de Medicina, Universidad de Murcia, 30100 Murcia, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology—ICO, and Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L’Hospitalet de Llobregat, Spain; (C.B.); (A.A.)
| | - Eva Ardanaz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
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49
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Burgui C, Martín C, Aguinaga A, Pérez-García A, Ezpeleta C, Castilla J. Prevalence and detection of undiagnosed active hepatitis C virus infections in Navarre, Spain, 2017-2019. Rev Esp Enferm Dig 2021; 113:28-34. [PMID: 33207891 DOI: 10.17235/reed.2020.7000/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND undiagnosed active hepatitis C virus (HCV) infection remains an obstacle towards its eradication. This study aimed to estimate the prevalence of HCV infection and to describe the diagnostic advances in Navarre, Spain. METHODS HCV-infection diagnostic performance was analyzed in Navarre's primary and specialized health care between 2017 and 2019. The prevalence of undiagnosed infections was estimated for patients with programmed surgeries unrelated to HCV infection, who underwent a routine HCV antibody (anti-HCV) determination. HCV-RNA (viral load) was quantified in anti-HCV positive cases. The prevalence was standardized according to the sex and age distribution in the general population. RESULTS from the 63,405 subjects examined for anti-HCV, 84 (five per 100,000 person-years) were diagnosed with an active infection. In Primary Health Care, 20,363 patients were analyzed and 47 active infections were detected, i.e. one case for every 433 people tested, implying 56 % of all identified active infections. On the other hand, 9,399 surgical patients were analyzed and 120 anti-HCV positive cases were detected (adjusted prevalence: 1.47 %; 95 % CI: 1.24-1.52). A positive viral load had been determined at any time in 66 cases (0.61 %), of which five were undiagnosed active infections (adjusted prevalence: 0.04 %; 95 % CI: 0.01-0.11). Preoperative screening allowed the detection of one undiagnosed infection per 795 people analyzed aged between 45 and 64 years. CONCLUSIONS Primary Health Care efficiently contributes to the detection of undiagnosed HCV active infections. This may be speeded up by performing population screening, targeting subjects between 45 and 64 years of age.
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Affiliation(s)
- Cristina Burgui
- Epidemiología, Instituto de Salud Pública de Navarra, España
| | - Carmen Martín
- Microbiología Clínica, Complejo Hospitalario de Navarra
| | | | | | | | - Jesús Castilla
- Epidemiología, Instituto de Salud Pública y Laboral de Navarra, España
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50
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Burgui C, Martín C, Juanbeltz R, San Miguel R, Martínez-Baz I, Zozaya JM, Castilla J. Recapture of patients with an incomplete diagnosis of hepatitis C virus infection. Rev Esp Enferm Dig 2021; 112:525-531. [PMID: 32515981 DOI: 10.17235/reed.2020.6944/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND hepatitis C virus (HCV) antibody tests have been performed since the 90s, although HCV-RNA (viral load) determination was not always performed. Some of these patients may be actively infected and not be aware of it. Here, we describe a procedure to capture these subjects and complete their diagnosis. METHODS the historical laboratory results of Navarra were reviewed and individuals who were positive for antibodies against HCV (anti-HCV) and had not undergone HCV-RNA testing were identified. In September 2018, each general practitioner (GP) was informed about their patients and given precise instructions for completing the diagnosis. The procedure was assessed until December 2019. RESULTS two hundred and eighty-nine anti-HCV positive patients were detected for whom active infection had not been discarded. Two were HIV-positive and six had already died. GPs were asked to assess the remaining 281 subjects. By the end of 2019, a new blood test had been performed in 187 (67 %) patients, 5 % decided not to do it, 4 % were living outside of Navarra, 3 % could not be contacted and the GP considered that it was not justified in 2 % of cases. Thus, 19 % remained to be contacted. From the 187 assessed patients, active infection was confirmed in 52 (28 %) individuals, 40 % were false positives and HCV-RNA was undetectable in 31 %. Regarding the 52 actively infected subjects, 34 had already initiated antiviral therapy and three were hospitalized due to decompensated cirrhosis, from which one patient died. CONCLUSIONS the strategy to recapture individuals with an incomplete HCV infection diagnosis was effective to detect active infections and subsequent initiation of antiviral therapy.
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Affiliation(s)
- Cristina Burgui
- Epidemiología, Instituto de Salud Pública de Navarra, España
| | - Carmen Martín
- Microbiología Clínica, Complejo Hospitalario de Navarra
| | | | | | - Iván Martínez-Baz
- Salud Pública, Instituto de Salud Pública de Navarra (IdiSNA), España
| | | | - Jesús Castilla
- Epidemiología, Instituto de Salud Pública y Laboral de Navarra, España
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