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Parisi A, Nuñez O, López-Perea N, Masa-Calles J. Reduced pertussis disease severity in infants following the introduction of pertussis vaccination of pregnant women in Spain, 2015-2019. Vaccine 2024; 42:2810-2816. [PMID: 38531728 DOI: 10.1016/j.vaccine.2024.03.028] [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: 08/26/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Maternal pertussis vaccination during the third trimester of pregnancy was implemented in 2015 in Spain, reaching a national coverage of 84% in 2019. In this ecological study, we investigated whether there was a change in the disease severity for pertussis in infants upon introduction of prenatal pertussis vaccination. METHODS We performed a time-trend analysis of infant pertussis hospitalizations during 2005-2019 in Spain using national register data. Annual hospitalization rates per 100,000 population and the mean length of hospitalization were calculated for infants < 3 months of age (target group benefiting from the prenatal vaccination) and a reference group aged 3-11 months. We compared overall rates and annual percent changes of the above variables in both groups for the time period before (2005-2014) and after vaccination introduction (2015-2019), using segmented Poisson regression. RESULTS During the pre-vaccination period, infants aged 0-2 months had a 5-times higher rate of pertussis hospitalization and spent on average 50 % longer in hospital than the reference group. After the maternal vaccination introduction, the hospitalization rate decreased more rapidly in infants aged 0-2 months than in infants aged 3-11 months: annual reduction of 34 % (95 % CI: 31-38) versus 26 % (95 % CI: 21-31) in the hospitalization rate and 13 % (95 % CI: 11-15) versus 6 % (95 % CI: 2-9) in the mean hospital stay, respectively. In 2019, the mean hospital stay for pertussis was about 4.5 days in both groups. CONCLUSIONS Maternal pertussis vaccination in Spain led to a reduction in disease severity in the target group as compared to older infants, highlighting the need for increased efforts on educating healthcare professionals on the importance of maternal vaccinations.
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Affiliation(s)
- Andrea Parisi
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Olivier Nuñez
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Noemí López-Perea
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Josefa Masa-Calles
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Launes C, Camacho J, Pons-Espinal M, López-Labrador FX, Esteva C, Cabrerizo M, Fernández-García MD, Fogeda M, Masa-Calles J, López-Perea N, Echevarría JE, Muñoz-Almagro C, Tarragó D. Hybrid capture shotgun sequencing detected unexpected viruses in the cerebrospinal fluid of children with acute meningitis and encephalitis. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04795-x. [PMID: 38438704 DOI: 10.1007/s10096-024-04795-x] [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: 01/17/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE Investigation of undiagnosed cases of infectious neurological diseases, especially in the paediatric population, remains a challenge. This study aimed to enhance understanding of viruses in CSF from children with clinically diagnosed meningitis and/or encephalitis (M/ME) of unknown aetiology using shotgun sequencing enhanced by hybrid capture (HCSS). METHODS A single-centre prospective study was conducted at Sant Joan de Déu University Hospital, Barcelona, involving 40 M/ME episodes of unknown aetiology, recruited from May 2021 to July 2022. All participants had previously tested negative with the FilmArray Meningitis/Encephalitis Panel. HCSS was used to detect viral nucleic acid in the patients' CSF. Sequencing was performed on Illumina NovaSeq platform. Raw sequence data were analysed using CZ ID metagenomics and PikaVirus bioinformatics pipelines. RESULTS Forty episodes of M/ME of unknown aetiology in 39 children were analysed by HCSS. A significant viral detection in 30 CSF samples was obtained, including six parechovirus A, three enterovirus ACD, four polyomavirus 5, three HHV-7, two BKV, one HSV-1, one VZV, two CMV, one EBV, one influenza A virus, one rhinovirus, and 13 HERV-K113 detections. Of these, one sample with BKV, three with HHV-7, one with EBV, and all HERV-K113 were confirmed by specific PCR. The requirement for Intensive Care Unit admission was associated with HCSS detections. CONCLUSION This study highlights HCSS as a powerful tool for the investigation of undiagnosed cases of M/ME. Data generated must be carefully analysed and reasonable precautions must be taken before establishing association of clinical features with unexpected or novel virus findings.
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Affiliation(s)
- Cristian Launes
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Departament de Medicina i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Juan Camacho
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda- Pozuelo km 2, 28220, Majadahonda, Spain
| | - Marina Pons-Espinal
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - F Xavier López-Labrador
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Genomics & Health Department, FISABIO-Public Health Foundation, Valencia, Spain
- Department of Microbiology and Ecology, Medical School, University of Valencia, Valencia, Spain
| | - Cristina Esteva
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María Cabrerizo
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda- Pozuelo km 2, 28220, Majadahonda, Spain
| | - María Dolores Fernández-García
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda- Pozuelo km 2, 28220, Majadahonda, Spain
| | | | - Josefa Masa-Calles
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Avda Monforte de Lemos 5, Madrid, Spain
| | - Noemí López-Perea
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Avda Monforte de Lemos 5, Madrid, Spain
| | - Juan Emilio Echevarría
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda- Pozuelo km 2, 28220, Majadahonda, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - David Tarragó
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda- Pozuelo km 2, 28220, Majadahonda, Spain.
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Gavilán AM, Perán-Ramos P, Sanz JC, García-Comas L, Pérez-Abeledo M, Castellanos AM, Berciano JM, López-Perea N, Masa-Calles J, Echevarría JE, Fernández-García A. Investigating Local Patterns of Mumps Virus Circulation, Using a Combination of Molecular Tools. Viruses 2023; 15:2420. [PMID: 38140661 PMCID: PMC10747990 DOI: 10.3390/v15122420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Mumps is a vaccine-preventable disease caused by the mumps virus (MuV). However, MuV has re-emerged in many countries with high vaccine coverage. The World Health Organization (WHO) recommends molecular surveillance based on sequencing of the small hydrophobic (SH) gene. Additionally, the combined use of SH and non-coding regions (NCR) has been described in different studies, proving to be a useful complement marker to discriminate general patterns of circulation at national and international levels. The aim of this work is to test local-level usefulness of the combination of SH and MF-NCR sequencing in tracing hidden transmission clusters and chains during the last epidemic wave (2015-2020) in Spain. A database with 903 cases from the Autonomous Community of Madrid was generated by the integration of microbiological and epidemiological data. Of these, 453 representative cases were genotyped. Eight different SH variants and thirty-four SH haplotypes were detected. Local MuV circulation showed the same temporal pattern previously described at a national level. Only two of the thirteen previously identified outbreaks were caused by more than one variant/haplotype. Geographical representation of SH variants allowed the identification of several previously undetected clusters, which were analysed phylogenetically by the combination of SH and MF-NCR, in a total of 90 cases. MF-NCR was not able to improve the discrimination of geographical clusters based on SH sequencing, showing limited resolution for outbreak investigations.
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Affiliation(s)
- Ana M. Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
| | - Paula Perán-Ramos
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
| | - Juan Carlos Sanz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, 28055 Madrid, Spain;
| | - Luis García-Comas
- Servicio de Epidemiología, Consejería de Sanidad de la Comunidad de Madrid, 28009 Madrid, Spain;
| | - Marta Pérez-Abeledo
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, 28055 Madrid, Spain;
| | - Ana M. Castellanos
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
| | - José M. Berciano
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/IdiPAZ, 28049 Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan E. Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.G.); (J.M.B.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.C.S.); (N.L.-P.); (J.M.-C.)
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Gavilán AM, van de Nes-Reijnen L, Castellanos A, Woudenberg T, López-Perea N, Masa-Calles J, Echevarría JE, Fernández-García A, Bodewes R. Comparison of circulation patterns of mumps virus in the Netherlands and Spain (2015-2020). Front Microbiol 2023; 14:1207500. [PMID: 37396375 PMCID: PMC10311905 DOI: 10.3389/fmicb.2023.1207500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Background Mumps is a viral infection mainly characterized by inflammation of the parotid glands. Despite of vaccination programs, infections among fully vaccinated populations were reported. The World Health Organization (WHO) recommends molecular surveillance of mumps based on sequencing of the small hydrophobic (SH) gene. The use of hypervariable non-coding regions (NCR) as additional molecular markers was proposed in multiple studies. Circulation of mumps virus (MuV) genotypes and variants in different European countries were described in the literature. From 2010 to 2020, mumps outbreaks caused by genotype G were described. However, this issue has not been analyzed from a wider geographical perspective. In the present study, sequence data from MuV detected in Spain and in The Netherlands during a period of 5 years (2015- March 2020) were analyzed to gain insights in the spatiotemporal spread of MuV at a larger geographical scale than in previous local studies. Methods A total of 1,121 SH and 262 NCR between the Matrix and Fusion protein genes (MF-NCR) sequences from both countries were included in this study. Analysis of SH revealed 106 different haplotypes (set of identical sequences). Results Of them, seven showing extensive circulation were considered variants. All seven were detected in both countries in coincident temporal periods. A single MF-NCR haplotype was detected in 156 sequences (59.3% of total), and was shared by five of the seven SH variants, as well as three minor MF-NCR haplotypes. All SH variants and MF-NCR haplotypes shared by both countries were detected first in Spain. Discussion Our results suggest a transmission way from south to north Europe. The higher incidence rate of mumps in Spain in spite of similar immunization coverage in both countries, could be associated with higher risk of MuV exportation. In conclusion, the present study provided novel insights into the circulation of MuV variants and haplotypes beyond the borders of single countries. In fact, the use of MF-NCR molecular tool allowed to reveal MuV transmission flows between The Netherlands and Spain. Similar studies including other (European) countries are needed to provide a broader view of the data presented in this study.
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Affiliation(s)
- Ana M. Gavilán
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Linda van de Nes-Reijnen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Ana Castellanos
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Tom Woudenberg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Juan E. Echevarría
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Aurora Fernández-García
- Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), ISCIII, Madrid, Spain
| | - Rogier Bodewes
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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5
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Jacqueline C, Gavilán AM, López-Perea N, Penedos AR, Masa-Calles J, Echevarría JE, Fernández-García A. Utility of MF-non coding region for measles molecular surveillance during post-elimination phase, Spain, 2017-2020. Front Microbiol 2023; 14:1143933. [PMID: 37283922 PMCID: PMC10240958 DOI: 10.3389/fmicb.2023.1143933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 06/08/2023] Open
Abstract
Background In countries entering the post-elimination phase for measles, the study of variants by sequencing of 450 nucleotides of the N gene (N450) does not always allow the tracing of chains of transmission. Indeed, between 2017 and 2020, most measles virus sequences belonged to either the MVs/Dublin.IRL/8.16 (B3-Dublin) or the MVs/Gir Somnath.IND/42.16 (D8-Gir Somnath) variants. We evaluated the additional use of a non-coding region (MF-NCR) as a tool to enhance resolution and infer case origin, chains of transmission and characterize outbreaks. Methods We obtained 115 high-quality MF-NCR sequences from strains collected from Spanish patients infected with either B3-Dublin or D8-Gir Somnath variants between 2017 and 2020, performed epidemiological, phylogenetic and phylodynamic analyses and applied a mathematical model to determine relatedness among identified clades. Results Applying this model allowed us to identify phylogenetic clades potentially derived from concomitant importations of the virus rather than single chain of transmission, inferred based on only N450 and epidemiology data. In a third outbreak, we found two related clades that corresponded to two chains of transmission. Discussion Our results show the ability of the proposed method to improve identification of simultaneous importations in the same region which could trigger enhanced contact tracing. Moreover, the identification of further transmission chains indicates that the size of import-related outbreaks was smaller than previously found, supporting the interpretation that endemic measles transmission was absent in Spain between 2017 and 2020. We suggest considering the use of the MF-NCR region in conjunction with the study of N450 variants in future WHO recommendations for measles surveillance.
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Affiliation(s)
- Camille Jacqueline
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Ana María Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan E. Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Majadahonda, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Pampaka D, López-Perea N, Fernández-García A, Huertas-Zarco I, Castellanos-Martínez M, Villatoro-Bongiorno K, Roig-Sena J, Torner N, Mar Mosquera M, Echevarría JE, Prats JF, Masa-Calles J. An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018. Euro Surveill 2023; 28. [PMID: 37103785 DOI: 10.2807/1560-7917.es.2023.28.17.2200634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Given sustained high vaccination coverage and enhanced surveillance for measles, Spain has been free of endemic measles transmission since 2014, achieving elimination certification from the World Health Organization in 2017. In November 2017, measles was introduced through an imported case travelling to the Valencian Community, causing an interregional outbreak. Here, we describe the outbreak using data reported to the national epidemiological surveillance network. The outbreak involved 154 cases (67 males, 87 females) notified in four regions; 148 were laboratory-confirmed and six epidemiologically linked. Most cases were adults aged 30-39 (n = 62, 40.3%) years. Sixty-two cases were hospitalised (40.3%) and 35 presented complications (22.7%). Two thirds of the cases (n = 102) were unvaccinated including 11 infants (≤ 1 year) not yet eligible for vaccination. The main route of transmission was nosocomial; at least six healthcare facilities and 41 healthcare workers and support personnel were affected. Sequencing of the viral nucleoprotein C-terminus (N450) identified genotype B3, belonging to the circulating MVs/Dublin.IRL/8.16-variant. Control measures were implemented, and the outbreak was contained in July 2018. The outbreak highlighted that raising awareness about measles and improving the vaccination coverage in under-vaccinated subgroups and personnel of healthcare facilities are key measures for prevention of future outbreaks.
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Affiliation(s)
- Despina Pampaka
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Huertas-Zarco
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Maite Castellanos-Martínez
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Katja Villatoro-Bongiorno
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Javier Roig-Sena
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Nuria Torner
- Universitat de Barcelona, Barcelona, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - María Mar Mosquera
- Microbiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Juan Emilio Echevarría
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Josefa Masa-Calles
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
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7
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Gavilán AM, Díez-Fuertes F, Sanz JC, Castellanos AM, López-Perea N, Jiménez SM, Ruiz-Sopeña C, Masa-Calles J, García-Comas L, de Ory F, Pérez-Olmeda M, Fernández-García A, Echevarría JE. Increase of Diversity of Mumps Virus Genotype G SH Variants Circulating Among a Highly Immunized Population: Spain, 2007-2019. J Infect Dis 2022; 227:151-160. [PMID: 35524966 DOI: 10.1093/infdis/jiac176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/19/2023] Open
Abstract
MuV caused three epidemic waves in Spain since genotype G emerged in 2005, despite high vaccination coverage. SH gene sequencing according to WHO protocols allowed the identification of seven relevant variants and 88 haplotypes. While the originally imported MuVi/Sheffield.GBR/1.05/-variant prevailed during the first two waves, it was subsequently replaced by other variants originated by either local evolution or importation, according to the additional analysis of hypervariable NCRs. The time of emergence of the MRCA of each MuV variant clade was concordant with the data of the earliest sequence. The analysis of Shannon entropy showed an accumulation of variability on six particular positions as the cause of the increase on the number of circulating SH variants. Consequently, SH gene sequencing needs to be complemented with other more variable markers for mumps surveillance immediately after the emergence of a new genotype, but the subsequent emergence of new SH variants turns it unnecessary.
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Affiliation(s)
- A M Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - F Díez-Fuertes
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - J C Sanz
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Madrid, Spain
| | - A M Castellanos
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - N López-Perea
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - S M Jiménez
- Servicio de Microbiología, Hospital de Segovia, Segovia, Spain
| | - C Ruiz-Sopeña
- Servicio de Epidemiología, Consejería de Sanidad de Castilla y León, Valladolid, Spain
| | - J Masa-Calles
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - L García-Comas
- Servicio de Epidemiología, Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
| | - F de Ory
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - M Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - A Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - J E Echevarría
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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8
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Pampaka D, Gómez-Barroso D, López-Perea N, Carmona R, Portero RC. Meteorological conditions and Legionnaires' disease sporadic cases-a systematic review. Environ Res 2022; 214:114080. [PMID: 35964674 DOI: 10.1016/j.envres.2022.114080] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
A number of studies suggest that meteorological conditions are related to the risk of Legionnaires' disease (LD) but the findings are not consistent. A systematic review was conducted to investigate the association of weather with sporadic LD and highlight the key meteorological conditions related to this outcome. PubMed, EMBASE, The Cochrane Library and OpenGrey were searched on 26-27 March 2020 without date, language or location restrictions. Key words included "legionellosis", "legionnaires' disease", combined with "meteorological conditions", "weather", "temperature", "humidity", "rain", "ultraviolet rays", "wind speed", etc. Studies were excluded if they did not examine the exposure of interest, the outcome of interest and their association or if they only reported LD outbreak cases. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and it was registered in PROSPERO (#CRD42020168869). There were 811 articles, of which 17 were included in the review. The studies investigated different meteorological variables and most of them examined the combined effect of several variables. The most commonly examined factors were precipitation and temperature, followed by relative humidity. The studies suggested that increased precipitation, temperature and relative humidity were positively associated with the incidence of LD. There was limited evidence that higher wind speed, pressure, visibility, UV radiation and longer sunshine duration were inversely linked with the occurrence of LD. A period of increased but not very high temperatures, followed by a period of increased precipitation, favour the occurrence of LD. Increased awareness of the association of temperature and precipitation and LD occurrence among clinicians and public health professionals can improve differential diagnosis for cases of sporadic community-acquired pneumonia and at the same time contribute to improving LD surveillance.
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Affiliation(s)
- Despina Pampaka
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Diana Gómez-Barroso
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiologia y Salud Publica, Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiologia y Salud Publica, Instituto de Salud Carlos III, Madrid, Spain
| | - Rocio Carmona
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Cano Portero
- National Centre of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiologia y Salud Publica, Instituto de Salud Carlos III, Madrid, Spain
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9
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Chirlaque López MD, Cabrerizo M, Guzmán Herrador BR, Masa-Calles J, Alarcón-Linares ME, Allende A, Aznar Cano E, Barranco Boada MI, Cantero Gudino E, Fernández-Balbuena S, Fernández Dueñas A, Fernández-García MD, García Hernández L, García Ortúzar V, López-Perea N, Martínez-Salcedo E, Moreno-Docón A, Ordobás Gavín M, Rodero Garduño I, Sierra Moros MJ, Simón Soria F, Limia Sánchez A, Suárez Rodríguez B. An imported case of vaccine-derived poliovirus type 2, Spain in the context of the ongoing polio Public Health Emergency of International Concern, September 2021. Euro Surveill 2021; 26:2101068. [PMID: 34915974 PMCID: PMC8728495 DOI: 10.2807/1560-7917.es.2021.26.50.2101068] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
Abstract
The monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.
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Affiliation(s)
- María Dolores Chirlaque López
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- IMIB-Arrixaca, Murcia University, Murcia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María Cabrerizo
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Polio Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Bernardo R Guzmán Herrador
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Josefa Masa-Calles
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | | | - Ana Allende
- Research Group on Microbiology and Quality of Fruit and Vegetables, Food Science and Technology Department, CEBAS-CSIC, Espinardo, Murcia, Spain
| | - Esteban Aznar Cano
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | | | - Elena Cantero Gudino
- Immunization Programme Area, Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Sonia Fernández-Balbuena
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Ana Fernández Dueñas
- Immunization Programme Area, Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | | | - Laura García Hernández
- Epidemiology and Prevention Service, Public Health General Direction, Canary Islands Health Service, Santa Cruz de Tenerife, Spain
| | | | - Noemí López-Perea
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- National Centre of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Eduardo Martínez-Salcedo
- Neuropediatric Unit, Department of Paediatrics, University Hospital Virgen of Arrixaca, Murcia, Spain
- IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Antonio Moreno-Docón
- Microbiology Service. Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
- IMIB-Arrixaca, Murcia University, Murcia, Spain
| | | | | | - Maria José Sierra Moros
- CIBER in Infectious Diseases (CIBERINFEC), Madrid, Spain
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Fernando Simón Soria
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Aurora Limia Sánchez
- Immunization Programme Area, Directorate General of Public Health, Ministry of Health, Madrid, Spain
| | - Berta Suárez Rodríguez
- Coordinating Centre for Health Alerts and Emergencies (CCAES), Directorate General of Public Health, Ministry of Health, Madrid, Spain
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10
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López-Perea N, Fernández-García A, Echevarría JE, de Ory F, Pérez-Olmeda M, Masa-Calles J. Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014-2020. Viruses 2021; 13:v13101982. [PMID: 34696412 PMCID: PMC8537497 DOI: 10.3390/v13101982] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.
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Affiliation(s)
- Noemí López-Perea
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
| | - Aurora Fernández-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- Correspondence:
| | - Juan Emilio Echevarría
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Fernando de Ory
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain
| | - Josefa Masa-Calles
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
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11
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Masa-Calles J, López-Perea N, Vila Cordero B, Carmona R. [Surveillance and epidemiology of Herpes Zoster in Spain.]. Rev Esp Salud Publica 2021; 95:e202106088. [PMID: 34168107] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/23/2021] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE Herpes Zoster (HZ) results from reactivation of latent varicella-zoster virus infection and is associated with immunosuppression and ageing. HZ is of increasing importance in advanced societies. Vaccination appears as a powerful tool to reduce HZ as well as postherpetic neuralgia, the main zoster complication. This study aims to describe the temporal trend, the age and sex distribution of cases, hospitalisations and deaths by zoster occurred in Spain between 1998 and 2018. METHODS The available information for zoster in Spain were used: cases from National Surveillance System (2014-2018), registries from Spanish hospitalisation database (1998-2018) and deaths from the Spanish mortality statistics (1999-2018). Incidence, hospitalization (HR) and mortality (MR) rates per year and period were calculated. Rates by age group and sex as well as percentage and cumulative percentage for cases and hospitalisations by age group, were also calculated. RESULTS The global HZ incidence was 351.6/100,000 inhabitants and 625.5/100,000 among population aged 50 and over. The incidence increases with age, especially from the age of 50-54 years (41% increase over the 45-49 age group) and is always higher in women. The global HR was 6.75/100,000 and 15.7/100,000 in persons aged 50 and over; HR increases with age, especially from 60-64 years onwards (50% increase over 54-59 age group) and is always higher in men. The 68.8% of cases and 80.2% of hospitalisations for HZ occurred from the age of 50. CONCLUSIONS In Spain HZ is a frequent and severe entity in adults and elderly people requiring public health interventions. The demographic changes and the introduction of vaccination require continued monitoring of HZ behaviour in terms of incidence and severity.
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Affiliation(s)
- Josefa Masa-Calles
- Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España
- Ciber de Epidemiología y Salud Pública. Instituto de Salud Carlos III. Madrid. España
| | - Noemí López-Perea
- Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España
- Ciber de Epidemiología y Salud Pública. Instituto de Salud Carlos III. Madrid. España
| | | | - Rocío Carmona
- Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España
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12
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Hoefer A, Pampaka D, Rivas Wagner E, Alemán Herrera A, García-Ramos Alonso E, López-Perea N, Cano Portero R, Herrera-León L, Herrera-León S, Núñez Gallo D. Management of a COVID-19 outbreak in a hotel in Tenerife, Spain. Int J Infect Dis 2020; 96:384-386. [PMID: 32425635 PMCID: PMC7231486 DOI: 10.1016/j.ijid.2020.05.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 10/26/2022] Open
Abstract
Since the first accounts of SARS-CoV-2, authorities have encountered numerous unprecedented situations threatening public health. This rapid communication addresses events that led to the quarantining of a hotel in Tenerife, Spain and the effectiveness of the rapidly implemented control measures. In total, eight cases have been associated with the hotel. Due to the international nature of the guests, had these timely precautions not been in place, a multinational cluster might have formed.
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Affiliation(s)
- Andreas Hoefer
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Despina Pampaka
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Eva Rivas Wagner
- Área Técnica de Salud Pública, Gerencia de Atención Primaria de Tenerife, Servicio Canario de Salud, Tenerife, Spain
| | - Araceli Alemán Herrera
- Dirección General de Salud Pública, Comunidad Autónoma de las Islas Canarias, Tenerife, Spain
| | | | - Noemí López-Perea
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiologia y Salud Publica, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Cano Portero
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiologia y Salud Publica, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Herrera-León
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiologia y Salud Publica, Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Herrera-León
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Domingo Núñez Gallo
- Dirección General de Salud Pública, Comunidad Autónoma de las Islas Canarias, Tenerife, Spain
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13
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Masa-Calles J, López-Perea N, Godoy P. Perfil epidemiológico del sarampión en España: casos en adultos, secundarios a la importación y asociados con la asistencia sanitaria. Semergen 2020; 46:77-80. [DOI: 10.1016/j.semerg.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
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14
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Masa-Calles J, Torner N, López-Perea N, Torres de Mier MDV, Fernández-Martínez B, Cabrerizo M, Gallardo-García V, Malo C, Margolles M, Portell M, Abadía N, Blasco A, García-Hernández S, Marcos H, Rabella N, Marín C, Fuentes A, Losada I, Gutiérrez JG, Nieto A, Ortúzar VG, Cenoz MG, Arteagoitia JM, Martínez ÁB, Rivas A, Castrillejo D. Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years' experience, Spain, 1998 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 30482263 PMCID: PMC6341937 DOI: 10.2807/1560-7917.es.2018.23.47.1700423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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
Acute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000–0.78/100,000). Two periods (P) are described: P1 (1998–2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007–2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain–Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.
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Affiliation(s)
- Josefa Masa-Calles
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Torner
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Public Health Agency of Catalonia, Generalitat of Catalonia, Spain.,Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - María de Viarce Torres de Mier
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Fernández-Martínez
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - María Cabrerizo
- National Polio Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Carmen Malo
- Servicio de Vigilancia en Salud Pública, D.G. de Salud Pública, Departamento de Sanidad, Aragón, Spain
| | - Mario Margolles
- Servicio de Vigilancia Epidemiológica, Consejería de Sanidad, Instituto de Investigación Sanitaria del Principado de Asturias, Spain
| | - Margarita Portell
- Servicio de Vigilancia Epidemiológica, Conselleria de Salut, Família i Bienestar Social Baleares, Spain
| | - Natividad Abadía
- Servicio de Epidemiologia y Prevención, Dirección General Salud Pública, Servicio Canario de Salud, Canarias, Spain
| | - Aniceto Blasco
- Sección de Vigilancia Epidemiológica, D.G. de Salud Pública, Cantabria, Spain
| | - Sara García-Hernández
- Servicio de Epidemiología, D.G. de Salud Pública, Consejería de Sanidad, Castilla-La Mancha, Spain
| | - Henar Marcos
- Servicio de Vigilancia Epidemiológica y Enfermedades Transmisibles, D.G. de Salud Pública, Consejería de Sanidad, Castilla y León, Spain
| | - Núria Rabella
- Microbiology Department, Hospital de la Santa Creu i Sant Pau, Microbiology & Genetics Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Celia Marín
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Spain
| | - Amelia Fuentes
- Subdirección de Epidemiología. D.G. de Salud Pública, Servicio Extremeño de Salud, Consejería de Salud y Políticas Sociales, Extremadura, Spain
| | - Isabel Losada
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Spain
| | - Juan García Gutiérrez
- Servicio de Epidemiología, Subdirección General de Epidemiología, Dirección General de Salud Pública, Comunidad Autónoma de Madrid, Spain
| | - Alba Nieto
- Servicio de Epidemiología, Subdirección General de Epidemiología, Dirección General de Salud Pública, Comunidad Autónoma de Madrid, Spain
| | - Visitación García Ortúzar
- Servicio de Epidemiología, D. G. de Salud Pública y Adicciones, Consejería de Salud, Región de Murcia, Spain
| | - Manuel García Cenoz
- Servicio de Epidemiología y Prevención Sanitaria, Instituto de Salud Pública de Navarra, IdiSNA, Spain.,Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - José María Arteagoitia
- Servicio de vigilancia epidemiológica y vacunas, Dirección de Salud Pública y Adicciones, Departamento de Salud, País Vasco, Spain
| | - Ángela Blanco Martínez
- Sección de Vigilancia Epidemiológica y Control de Enfermedades Transmisibles, D.G de Salud Pública y Consumo, Consejería de Salud, La Rioja, Spain
| | - Ana Rivas
- Servicio de Epidemiología, Consejería de Sanidad y Consumo, Ceuta, Spain
| | - Daniel Castrillejo
- Servicio de Epidemiología, D.G. de Sanidad y Consumo, Consejería de Presidencia y Salud Pública, Melilla, Spain
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15
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Gavilán AM, Fernández-García A, Rueda A, Castellanos A, Masa-Calles J, López-Perea N, Torres de Mier MV, de Ory F, Echevarría JE. Genomic non-coding regions reveal hidden patterns of mumps virus circulation in Spain, 2005 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29667574 PMCID: PMC6836197 DOI: 10.2807/1560-7917.es.2018.23.15.17-00349] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since mumps vaccination was introduced in 1981 in Spain, the incidence of the disease has dropped significantly. However, cyclic epidemic waves and outbreaks still occur, despite high vaccination coverage. The World Health Organization (WHO) recommends genotyping to trace the pattern of mumps virus (MuV) circulation. Genotype H was predominant in Spain, but was replaced in 2005 by genotype G which has subsequently remained dominant. Of the small hydrophobic protein gene sequences, 78% are identical and belong to the MuVi/ Sheffield.GBR.1.05/[G]-variant. Aim: Our study aimed to investigate whether the circulation of MuV strains in Spain was continuous after the emergence of genotype G in 2005. Method: We obtained 46 samples from Spanish patients infected with MuVi/Sheffield.GBR.1.05/[G] during two epidemic waves and analysed them using new molecular markers based on genomic non-coding regions (NCRs) that discriminate subvariants of this virus strain. Results: Phylogenetic analyses of the nucleoprotein–phosphoprotein and matrix protein–fusion protein NCR indicated strain replacement after a drop in incidence in 2009, which had not been detectable by SH sequencing. Clustering of sequences from patients epidemiologically linked in the same outbreak suggests a potential use for these NCRs in outbreak characterisation. Conclusion: We suggest to consider their use in conjunction with the SH gene in the future WHO recommendations for MuV epidemiological surveillance.
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Affiliation(s)
- Ana M Gavilán
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Aurora Fernández-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Angel Rueda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana Castellanos
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María V Torres de Mier
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando de Ory
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Juan E Echevarría
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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Seppälä EM, López-Perea N, Torres de Mier MDV, Echevarría JE, Fernández-García A, Masa-Calles J. Last cases of rubella and congenital rubella syndrome in Spain, 1997-2016: The success of a vaccination program. Vaccine 2018; 37:169-175. [PMID: 30454948 DOI: 10.1016/j.vaccine.2018.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/28/2018] [Accepted: 11/07/2018] [Indexed: 11/15/2022]
Abstract
With a highly immunized population, rubella infection in Spain is so low that the WHO has declared the elimination of rubella. Rubella in pregnant women is also very rare. The objective of this study is to describe the last cases of congenital rubella syndrome reported and recommend actions to maintain the status of the disease as eliminated. The CRS cases reported to the Spanish National Epidemiological Surveillance Network between 1997 and 2016 were studied, and the epidemiological, clinical, diagnostic and maternal characteristics of newborns with CRS described. The incidence of CRS was calculated using Birth Statistics from the Spanish National Statistics Agency (INE). Twenty-three cases of CRS were reported, 70% of which were associated with rubella outbreaks. The most common clinical conditions were heart disease (52.2%), deafness (39.1%) and cataracts (30.4%); 91.3% of cases were confirmed by laboratory testing. 70.0% were born from a non-vaccinated foreign mother, resident in Spain (cumulative rate incidence (CR): 1.1/100,000 births), with mothers coming from Africa (36.0%), Latin America (29.0%), Eastern Europe (21.0%) and Asia (14.0%). Six were born to Spanish mothers (CR: 0.08/ 100,000 births), the last of which were in 2005. The majority of CRS cases were born to unvaccinated immigrant women infected in Spain during rubella outbreaks. Universal vaccination in childhood is the most efficient strategy to prevent rubella. The limited circulation of the virus will, however, quickly lead to a loss of awareness about rubella among clinicians and epidemiologists. It is necessary to maintain protocols capable of identifying signs consistent with rubella in pregnant women and signs suggestive of congenital rubella in newborns.
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Affiliation(s)
| | - Noemí López-Perea
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - María de Viarce Torres de Mier
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - Juan E Echevarría
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220, Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - Aurora Fernández-García
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220, Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
| | - Josefa Masa-Calles
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health) CIBERESP, Spain.
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17
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Risco-Risco C, Masa-Calles J, López-Perea N, Echevarría JE, Rodríguez-Caravaca G. Epidemiología del sarampión en personas vacunadas, España 2003-2014. Enferm Infecc Microbiol Clin 2017; 35:569-573. [DOI: 10.1016/j.eimc.2016.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 12/01/2022]
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18
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Risco-Risco C, Masa-Calles J, López-Perea N, Echevarría JE, Rodríguez-Caravaca G. Epidemiology of measles in vaccinated people, Spain 2003–2014. Enferm Infecc Microbiol Clin 2017. [DOI: 10.1016/j.eimce.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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19
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López-Perea N, Masa-Calles J, Torres de Mier MDV, Fernández-García A, Echevarría JE, De Ory F, Martínez de Aragón MV. Shift within age-groups of mumps incidence, hospitalizations and severe complications in a highly vaccinated population. Spain, 1998-2014. Vaccine 2017; 35:4339-4345. [PMID: 28687402 DOI: 10.1016/j.vaccine.2017.06.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 11/30/2022]
Abstract
The mumps vaccine (Jeryl-Lynn-strain) was introduced in Spain in 1981, and a vaccination policy which included a second dose was added in 1995. From 1992-1999, a Rubini-strain based vaccine was administered in many regions but later withdrawn due to lack of effectiveness. Despite high levels of vaccination coverage, epidemics have continued to appear. We characterized the three epidemic waves of mumps between 1998 and 2014, identifying major changes in susceptible populations using Poisson regression. For the period 1998-2003 (P1), the most affected group was from 1 to 4years old (y) [Incidence Rate (IR)=71.7 cases/100,000 population]; in the periods 2004-2009 (P2) and 2010-2014 (P3) IR ratio (IRR) increased among 15-24y (P2=1.46; P3=2.68) and 25-34y (P2=2.17; P3=4.05). Hospitalization rate (HR), complication rate (CR) and neurological complication rate (NR) among hospitalized subjects decreased across the epidemics, except for 25-34y which increased: HR ratio (HRR) (P2=2.18; P3=2.16), CRR (P3=2.48), NRR (P3=2.41). In Spain mumps incidence increased, while an overall decrease of hospitalizations and severe complications occurred across the epidemics. Cohorts born during periods of low vaccination coverage and those vaccinated with Rubini-strain were the most affected populations, leading to a shift in mumps cases from children to adolescents and young adults; this also reveals the waning immunity provided by the mumps vaccine. Despite not preventing all mumps cases, the vaccine appears to prevent serious forms of the disease.
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Affiliation(s)
- Noemí López-Perea
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Josefa Masa-Calles
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - María de Viarce Torres de Mier
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Aurora Fernández-García
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Juan E Echevarría
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - Fernando De Ory
- National Microbiology Centre, Instituto de Salud Carlos III, Ctra. Majadahoda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
| | - María Victoria Martínez de Aragón
- National Epidemiology Centre, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029 Madrid, Spain; Centers for Biomedical Research Network (CIBER-Epidemiology and Public Health), Spain.
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20
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López-Perea N, Sordo L, Gadisa E, Cruz I, Hailu T, Moreno J, Aseffa A, Cañavate C, Custodio E. Knowledge, attitudes and practices related to visceral leishmaniasis in rural communities of Amhara State: a longitudinal study in northwest Ethiopia. PLoS Negl Trop Dis 2014; 8:e2799. [PMID: 24743328 PMCID: PMC3990515 DOI: 10.1371/journal.pntd.0002799] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/02/2014] [Indexed: 12/04/2022] Open
Abstract
Background In the northwest of Ethiopia, at the South Gondar region, there was a visceral leishmaniasis (VL) outbreak in 2005, making the disease a public health concern for the regional health authorities ever since. The knowledge on how the population perceives the disease is essential in order to propose successful control strategies. Methodology/Principal findings Two surveys on VL knowledge, attitudes and practices were conducted at the beginning (May 2009) and at the end (February 2011) of a VL longitudinal study carried out in rural communities of Libo Kemkem and Fogera, two districts of the Amhara Regional State. Results showed that VL global knowledge was very low in the area, and that it improved substantially in the period studied. Specifically, from 2009 to 2011, the frequency of proper knowledge regarding VL signs and symptoms increased from 47% to 71% (p<0.0001), knowledge of VL causes increased from 8% to 25% (p<0.0001), and knowledge on VL protection measures from 16% to 55% (p<0.0001). Moreover, the improvement observed in VL knowledge was more marked among the families with no previous history of VL case. Finally, in 2011 more than 90% of the households owned at least an impregnated bed net and had been sprayed, and attitudes towards these and other protective measures were very positive (over 94% acceptance for all of them). Conclusions/Significance In 2009 the level of knowledge regarding VL was very low among the rural population of this area, although it improved substantially in the study period, probably due to the contribution of many actors in the area. VL patients and relatives should be appropriately informed and trained as they may act as successful health community agents. VL risk behavioural patterns are subject to change as attitudes towards protective measures were very positive overall. Visceral leishmaniasis (VL) is a vector borne disease that can be fatal if left untreated. In northern Ethiopia there was a VL outbreak in 2005, making the disease a public health challenge ever since. In order to promote the participation of communities in the control of the disease, it is essential to know how they perceive the disease and its management. There is a paucity of studies dealing with the knowledge, attitudes and practices (KAP) towards VL in the world in general and in rural Ethiopia in particular. We conducted two KAP studies at the beginning and at the end of a VL longitudinal study carried out between 2009 and 2011. The project included VL community talks and sensitization, and there were other interventions implemented by different actors in this period. Our results showed that, among the rural communities surveyed, the knowledge regarding signs and symptoms, causes, and protective measures of the disease was very low. However, it improved substantially in the period studied, suggesting that knowledge was subject to change by community interventions. It also showed that VL patients and relatives can act as successful health agents and that the population had positive attitudes towards the implementation of preventive actions.
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Affiliation(s)
- Noemí López-Perea
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Sordo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Israel Cruz
- WHO Collaborating Center for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Tsegaye Hailu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Javier Moreno
- WHO Collaborating Center for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Carmen Cañavate
- WHO Collaborating Center for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Estefanía Custodio
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
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