[First wave of the COVID-19 pandemic in Navarre, Spain, February-June 2020]

BACKGROUND

The COVID-19 pandemic was declared in 2020. The shortage of diagnostic tests limited monitoring of the first wave of the pandemic. This study estimates and describes the wave in Navarre (Spain).

METHODS

Enhanced epidemiological surveillance, seroepidemiological survey estimates and mortality registries were used to characterise the first wave of the COVID-19 pandemic from February to June 2020 in Navarre.

RESULTS

A total of 10,358 persons (1.6?% of population) were confirmed with COVID-19, 1,943 cases were hospitalized (3 per 1,000 inhabitants), 139 were admitted to the ICU (21 per 100,000 inhabitants), and 529 people died from confirmed COVID-19 (80 per 100,000). Mortality increased exponentially with age, exceeding 1?% in people over 85 years. 58?% of deaths occurred amongst nursing home residents. The mortality registry received reporting of 733 confirmed or probable COVID-19 deaths, while the excess deaths during this period were 613 (20.9?%) concentrated from mid-March to the end of April. It is estimated that, at the end of June, 6.7?% (n?=?44,000) of the population had detectable antibodies against SARS-CoV-2 and 10.3?% had had the infection. The estimates of SARS-CoV-2 infection incidence increased sharply in the first half of March and decreased quickly during the home lockdown in the second half of March.

CONCLUSIONS

The first wave of the pandemic produced a high number of cases, hospitalizations and deaths in Navarre in a few weeks. The pronounced decrease of SARS-CoV-2 infections during the home lockdown suggests considerable efficacy and impact of this measure for transmission control.

Cause of death in hospitalized patients with laboratory-confirmed influenza

BACKGROUND

We analyzed the underlying cause of death recorded in hospitalized patients with laboratory-confirmed influenza.

METHODS

The present study included all patients with a laboratory-confirmed diagnosis of influenza during the influenza seasons 2009-2010 to 2013-2014 who were attended to in hospital and died. Their underlying cause of death according to the International Classification of Diseases 10th Revision was obtained from the Navarre Mortality Registry.

RESULTS

Among 49 patients studied, the underlying causes of death were 35% influenza, 4% pneumonia, 14% other respiratory diseases, 10% circulatory disease and 37% other causes.

CONCLUSIONS

Non-cardiorespiratory causes accounted for a third of deaths in patients with confirmed influenza, thus all-cause mortality should be considered in estimating the full burden of influenza mortality.

[Comparative study of HIV-1/2 antibody confirmatory assay: Geenius™ versus INNO-LIA™]

OBJECTIVE

The aim of the study is to compare two confirmatory tests for HIV-1/2 infection.

METHODS

A prospective study was carried out between 01/01/2015 and 12/31/2015. Serum samples with repeatedly positive results in the Antibody-Antigen-HIV-1/2 (Architect, Abbott) screening assay were included. The serum samples corresponding to new diagnosed cases were selected and were used to compare the two confirmatory assays: Geenius™ HIV-1/2 (Bio-Rad) and INNO-LIA™ HIV-1/2 score line-immunoassay (Innogene-tics®). The HIV-1 viral load (Cobas® AmpliPrepHIV, Ro-che) was performed in discordant or indeterminate cases.

RESULTS

Eight five samples were included. The results of both confirmatory assays were concordant in 80/85 samples: 53 HIV-1, 1 HIV-2, 25 negative and one indeterminate. Cohen's Kappa concordance coefficient between Geenius™ and INNO-LIA™ techniques was very high (0.878).

CONCLUSIONS

The concordance between the two assays is high. The procedure for Geenius™ is simple and fast. Geenius™ is a good alternative to include in the HIV-1/2 diagnostic algorithm.

Moderate influenza vaccine effectiveness against hospitalisation with A(H3N2) and A(H1N1) influenza in 2013-14: Results from the InNHOVE network

We conducted a multicentre test negative case control study to estimate the 2013-14 influenza vaccine effectiveness (IVE) against hospitalised laboratory confirmed influenza in 12 hospitals in France, Italy and Spain. We included all ≥18 years hospitalised patients targeted by local influenza vaccination campaign reporting an influenza-like illness within 7 days before admission. We defined as cases patients RT-PCR positive for influenza and as controls those negative for all influenza virus. We used a logistic regression to calculate IVE adjusted for country, month of onset, chronic diseases and age. We included 104 A(H1N1)pdm09, 157 A(H3N2) cases and 585 controls. The adjusted IVE was 42.8% (95%CI: 6.3;65;0) against A(H1N1)pdm09. It was respectively 61.4% (95%CI: -1.9;85.4), 39.4% (95%CI: -32.2;72.2) and 19.7% (95%CI:-148.1;74.0) among patients aged 18-64, 65-79 and ≥80 years. The adjusted IVE against A(H3N2) was 38.1% (95%CI: 8.3;58.2) overall. It was respectively 7.8% (95%CI: -145.3;65.4), 25.6% (95%CI: -36.0;59.2) and 55.2% (95%CI: 15.4;76.3) among patients aged 18-64, 65-79 and ≥80 years. These results suggest a moderate and age varying effectiveness of the 2013-14 influenza vaccine to prevent hospitalised laboratory-confirmed influenza. While vaccination remains the most effective prevention measure, developing more immunogenic influenza vaccines is needed to prevent severe outcomes among target groups.

Vaccine effectiveness in preventing laboratory-confirmed influenza in Navarre, Spain: 2013/14 mid-season analysis

We estimate mid-2013/14 season vaccine effectiveness (VE) of the influenza trivalent vaccine in Navarre, Spain. Influenza-like illness cases attended in hospital (n=431) and primary healthcare (n=344) were included. The overall adjusted VE in preventing laboratory-confirmed influenza was 24% (95% CI: -14 to 50). The VE was 40% (95% CI: -12 to 68) against influenza A(H1)pdm09 and 13% (95% CI: -36 to 45) against influenza A(H3). These results suggest a moderate preventive effect against influenza A(H1)pdm09 and low protection against influenza A(H3).

Impact of universal two-dose vaccination on varicella epidemiology in Navarre, Spain, 2006 to 2012

In 2007 in Navarre, Spain, universal varicella vaccination with two doses of Varivax was introduced in the childhood immunisation schedule for children aged 15 months and three years. This study describes changes in the epidemiology of varicella in the period 2006 to 2012 and evaluates vaccination effectiveness using epidemiological surveillance data. The incidence of varicella in children aged 0 to 14 years decreased by 98.1%, from 50.1 cases per 1,000 inhabitants in 2006, to 1.0 per 1,000 in 2012. Children aged one to eight years were the vaccinated cohorts, and their incidence of varicella decreased by 98.5% (p<0.0001). In unvaccinated age groups, important reductions were also achieved between 2006 and 2012: 90.5% (p<0.0001) in infants under one year of age, and 89.4% (p<0.0001) in children aged nine years. In the period 2006 to 2012, the hospital admissions rate for varicella or its complications decreased by 89.0%, and in 2012, there was only one admission of a newborn with neonatal varicella. Vaccine effectiveness for at least one dose was 96.8% (95% confidence interval: 96.3-97.2%). Universal vaccination with two doses has reduced varicella circulation to minimum levels within five years and has proved highly effective.

Early estimates of influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis

We present estimates of influenza vaccine effectiveness (VE) in Navarre, Spain, in the early 2012/13 season, which was dominated by influenza B. In a population-based cohort using electronic records from physicians, the adjusted VE in preventing influenzalike illness was 32% (95% confidence interval (CI): 15 to 46). In a nested test-negative case-control analysis the adjusted VE in preventing laboratory-confirmed influenza was 86% (95% CI: 45 to 96). These results suggest a high protective effect of the vaccine.

Early estimates of influenza vaccine effectiveness in Navarre, Spain: 2012/13 mid-season analysis

Binary file ES_Abstracts_Final_ECDC.txt matches

Decline in influenza vaccine effectiveness with time after vaccination, Navarre, Spain, season 2011/12

Binary file ES_Abstracts_Final_ECDC.txt matches

Influenza outbreaks in nursing homes with high vaccination coverage in Navarre, Spain, 2011/12

In the 2011/12 season, three influenza outbreaks were studied in nursing homes with high vaccination coverage in Navarre, Spain. Attack rates ranged from 2.9% to 67%. Influenza A/Stockholm/18/2011(H3N2) virus strain was isolated from the three outbreaks. Vaccination should be complemented with other hygiene measures in nursing homes. Early detection of influenza outbreaks in nursing homes can aid in their control.

Influenza outbreaks in nursing homes with high vaccination coverage in Navarre, Spain, 2011/12

In the 2011/12 season, three influenza outbreaks were studied in nursing homes with high vaccination coverage in Navarre, Spain. Attack rates ranged from 2.9% to 67%. Influenza A/Stockholm/18/2011(H3N2) virus strain was isolated from the three outbreaks. Vaccination should be complemented with other hygiene measures in nursing homes. Early detection of influenza outbreaks in nursing homes can aid in their control.

[Community-acquired bacteremia]

Bacteremia continues to be one of the main causes of mortality despite the existence of numerous antimicrobial agents and an increase in means of support. A variety of factors, such as the type of microorganism, age, the underlying disease and where the bacteremia was acquired, can change the prognosis of the infection. The aim of this study was to analyze the cases of community-acquired bacteremia gathered prospectively from the Basurto hospital in Bilbao, Spain. The incidence of bacteremia was estimated using preestablished protocol (SEPSIS-DATA) from January 1994 to September 2001. Information was gathered on all the cases of bacteremia at the hospital and only those which were of non-hospital origin (2886 cases) were selected for the study. In our hospital, 67.82% of the bacteremia cases were community-acquired, a figure which remained stable throughout the 8-year study period. A total of 54.64% of the patients were male, 1603 (55.54%) of whom were over age 60 years. The most common underlying diseases were diabetes (15.75%), neoplasia (14.96%) and HIV infection (12.9%). The majority of the cases (2216, 76.8%) were admitted to the general medicine ward, 335 (11.6%) to surgery, 200 (6.9%) to pediatrics and 135 (4.67%) to ICU. The origin of the bacteremia was urinary (33%), gastrointestinal (18%) or respiratory (18.26%). The most common microorganisms were E. coli (36%), S. pneumoniae (13%), S. aureus (9.46%), S. enteritidis (2.87%), P. aeruginosa (2.71%), P. mirabilis (2.65%) and N. meningitidis (2.45%). The bacteremia was polymicrobial in 6.27% of the cases. The most used antibiotics were ceftriaxone (31%), gentamicin (7.3%) and amoxicillin-clavulanic acid (6.9%). Overall mortality was 13.82%. The relative frequency of community-acquired/nosocomial infection remained stable in two-thirds of the total cases. The incidence of bacteremia decreased in the 20-40 year age group and in those with HIV infection. E. coli and S. pneumoniae increased, while S. aureus decreased. The use of imipenem and quinolones increased. E. coli resistance to quinolones increased from 3.54% in 1995 to 14.36% in 2000. Mortality decreased slightly, with no significant differences.

Detection of HGV in serum and peripheral blood mononuclear cells of maintenance haemodialysis patients

The aim of the present study was to investigate the prevalence of hepatitis G virus (HGV) and also hepatitis C virus (HCV) infections in maintenance haemodialysis patients, and to identify extrahepatic sites as HGV reservoirs. HGV RNA was detected in the serum of 6/61 (10%) patients and in the peripheral blood mononuclear cells of 2/61 (3%) patients (one of whom was serum negative). These findings suggest that lymphoid cells constitute an extrahepatic HGV reservoir. HCV RNA was detected in 7/61 (11%) patients. Five of these patients (71%) were identified as carrying HCV genotype 1b. Co-infection with HCV and HGV was detected only in one patient. Haemodialysis patients are at risk for HGV infection, by nosocomial routes or via transfusions. HGV itself does not seem to be an important cause of hepatitis since all six HGV RNA positive patients not co-infected by HCV or HBV showed normal ALT values.

[Description of 165 episodes of fungemia: A multicenter study.]

The aim of this article is to describe the main features of fungemia belonged to the Multicenter Study Sepsis Data realised in 34 spanish hospitals. The hospitals were been given a protocol and a software specially designed for this study. 165 episodes of fungemia has been recovered (total: 5,000 episodes of bacteremia). The main results are showed as follows. Sex: male 100 (60.6%); female 65 (39.4%). Areas: medical 64 (38.8%); intensive care unit 48 (29.1%); surgical 39 (23.6%); paediatric 14 (8.5%). Underlying disease: neoplasia 43 (26.1%); HIV infection 28 (16.9%); chronic obtructive pulmonary disease 18 (10.9%); diabetes mellitus and parenteral drug abuse 15 (9.1%) every one. Nosocomial fungemia: 119 (72.1%). Community-acquired fungemia: 42 (25.5%).

SOURCES

primary 41 (24.9%); catheter 40 (24.2%); respiratory 23 (13.9%); urinary 17 (10.3%); abdominal 8 (4.9%); skin/soft tissues 4 (4.4%); surgical wound 6 (3.6%). Fungi most often isolated: Candida albicans, 73 isolates (44.2%); Candida parapsilosis, 20 (12.1%); Cryptococcus spp., 12 (7.3%) and Candida glabrata, 6 (3.6%). Polymicrobial fungemia: 19 (11.5%). Fluconazole (54.4%) and amphotericin B (41.9%) were the antifungal agents most often used. Mortality: 33.3%.

[Genetic typing by PCR of isolates of C. albicans obtained in a resuscitation unit]

BACKGROUND

Typing by PCR (random polymorphic amplification or arbitrarily primed PCR) consists in a random amplification with the use of initiators of unknown homology with respect to the mold sequence. This study is of interest given the development of the technology of the amplification of nucleic acids and its application in the epidemiologic characterization of isolates of C. albicans.

METHODS

Fourteen strains isolates in blood cultures of 8 patients were studied. All were identified as C. albicans. For amplification the sequence of AP3 and ERIC2 were selected.

RESULTS

With one strain a band pattern very different from that obtained with the remaining isolates identified as C. albicans was achieved leading to reidentification and proving that it was C. parapsilopsis. On combining the results obtained with the use of both initiators 7 different genotypes were obtained with the remaining strains: A1, 2B, 3C, 4C, 5D, 6B and 7E.

CONCLUSIONS

The discriminative power of the two initiators was similar although the AP3 was greater obtaining one more genotype than ERIC2. The patients with repeated yeast isolates over time which may be considered as the same episode of bacteremia, each presented the same band pattern and each was infected by one single clone. We herewith confirm the usefulness of typing by PCR with one initiator by reaction. The results may be improved with the combination of the profiles obtained with the use of several sequences if greater discrimination is required. Likewise, its use has shown to be satisfactory in both the identification of clones within one species and the identification of species within the genus.

Serratia rubidaea as an invasive pathogen

Serratia rubidaea biotype 1 was isolated from the bile and blood of a patient with a bile tract carcinoma obstructing the common bile duct and who underwent invasive procedures. The infection was cleared after adequate treatment with antibiotics.

[Splenic abscess: clinico-microbiologic study of 15 cases]

We have reviewed 15 cases of splenic abscesses diagnosed using a histopathological and microbiological study. Mean age was 48 years (range 18-78). Eight of them were male and 7 female. Eighty per cent of them had predisposing diseases, amongst which the most frequent were endocarditis and bacteriemia of other origin (26.6% in both cases). All patients presented fever and in 7 of them (47%) splenomegaly was appreciated. The most frequently isolated germs were gramnegative bacteria (33%), anaerobics (20%), and with a similar incidence grampositive bacteria, tuberculosis and fungii; in only one case cultures were sterile. Seven patients had multiple splenic abscesses and 8 patients single abscesses. Thorax x-ray showed alterations in more than half of the patients (53%). Abdominal echography was the diagnostic method in 67% of the patients and TAC in all the cases in which it was performed. Eight patients underwent splenectomy and one was surgically drained being the mortality rate of this group of 22%. Overall mortality was 33% and was related to the presence of multiple splenic abscesses (5/7, 71.4%), positive hemocultures (6/6, 100%), extrasplenic abscesses (7/8, 87.5%), and endocarditis (4/4, 100%), fungii infections (2/2, 100%), and late diagnosis (6/6, 100%).

A "Pap" test for men? Male urethral smears as screening tool for detecting subclinical human papillomavirus infection

We have explored the potential of using immunoperoxidase staining and in situ DNA hybridization techniques to detect the HPV common antigen and HPV DNA (subtypes 6/11 and 16/18) in urethral smears obtained from men with no grossly visible urethral lesions, with or without HPV-related clinical history. A total of 91 such smears were studied of which 25 (27.5%) were positive for HPV antigen. Of the latter, 20 (80%) were positive for HPV 6/11 DNA, 3 (12%) were positive for HPV 16/18 DNA, one smear (4%) was positive for both, and one was negative for both. The technique of obtaining male urethral smears and immunostaining them for HPV antigen is simple, rapid, specific, and far more sensitive than conventional morphologic observations. Since antigen-positive cells are the source for spreading HPV infection, identifying individuals with such cells can help limit the spread of infection by alerting sexual partners, and also can be used to monitor the infectious status of the patient after therapy. DNA subtyping of HPV-positive patients may be useful in predicting the potential for malignant transformation which varies among the different HPV subtypes.

Blistering distal dactylitis in an adult

Streptococci are responsible for a diverse spectrum of cutaneous infections like erysipelas, impetigo, and cellulitis. Blistering distal dactylitis is an infrequent, superficial infection of the anterior fat pad of the distal portion of the finger described classically in children. We report a case of blistering distal dactylitis in an adult caused by group A beta-hemolytic streptococci that was cured with oral phenoxymethyl penicillin. Familiarity with blistering distal dactylitis should permit the dermatologist and internist to diagnose this new entity in adults.