Changes in the epidemiology of hepatitis A: Clinical and preventive implications

INTRODUCTION AND OBJECTIVES

Hepatitis A Virus Infection (HAI) has been related to the hygienic-sanitary situation of an area, the changes in the epidemiology of HAI in the province of Guadalajara between 1991 and 2017 are analyzed.

MATERIALS AND METHODS

Cases of HAI declared between 1991 and 2017 in Guadalajara were included. The variables analyzed were age, sex, environment, risk factors for HAI and need for hospitalization. The incidence was compared in three periods: 1991-1999, 2000-2008 and 2009-2017.

RESULTS

Two hundred and thirty-three cases of HAI were declared, the average incidence rate was 4.27 cases/100,000 inhabitants, highest between 1991 and 1999 (6.93) and lowest between 2009 and 2017 (1.92), with an increment in 2017 (5.5). The median age was 16 years (IR: 8.5-28.5 years), 58.4% were male, and the highest incidence occurred between 5 and 14 years in both sexes. The most frequent risk factors were family and non-family contact and trips to endemic areas (18.6%, 17.3% and 18.2%, respectively). The last risk factor increased after 2000 (P=.001), as did the incidence in urban areas. The MSM group showed an increase in the last period (P<.001). Hospital admissions increased progressively from the first to the third period studied (P=.001).

CONCLUSIONS

HAI has a low incidence in our area. More cases related to travel or sexual practices are observed. This should be considered when establishing prevention policies, including vaccination of the most exposed people.

Active surveillance of antimicrobial resistance

The magnitude of the impact of antibiotic resistance (AR) is now well recognised. Implementation of measures for its control is essential, but for them to be efficacious and cost-effective, they must be guided by prior knowledge of the problem that is as up-to-date, real and complete as possible. However, the current scale of AR is difficult to quantify due to the wide heterogeneity of data collection, the existence of large gaps in surveillance capacity and its deficient coordination. Therefore, it is necessary to structure holistic, integrative and high-quality AR surveillance systems that allow the early analysis of combined data (micro-biological, clinical, epidemiological data) from different sources (humans, foods, animals and environment) to guide decision making for the control of AR. Some of the main characteristics that a structure of this scale should have are: a multidisciplinary consensus on protocols, criteria and techniques; the combination and coordination of different approaches seeking to fill possible gaps in surveillance; the deve lopment of a global antibiotic policy that allows and facilitates the existence of common, updated and accessible surveillance systems; the use of agile and compatible computer systems that allow a «real time» dump in common databases; and political involvement to include monitoring of AR in the political agenda and to commit the necessary resources. Supplement information: This article is part of a supplement entitled «SEIMC External Quality Control Programme. Year 2016», which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A. © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosasy Microbiología Clínica. All rights reserved.

[Kikuchi disease: Evolution during outbreaks and its response to antimalarial treatment]

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a syndrome characterized by the presence of usually painful cervical lymphadenopathy with fever and night sweats. It is a rare clinical entity that mainly affects young Asian women, although it found worldwide. It is a benign and self-limiting condition; however, its importance lies in its differential diagnosis with other clinical entities such as lymphoma or histiocytoma. We present a case of Kikuchi-Fujimoto disease, with special emphasis on its clinicopathological significance and its evolution during outbreaks. Antimalarial therapy causes remission and we discuss the use of hydroxychloroquine for reoccurring cases.

[Current therapy of multiple sclerosis]

Since the introduction of interferon beta 1 b for the treatment of multiple sclerosis, there has been a progressive increase in the number of drugs available for this disease. Currently, 11 drugs have been approved in Spain, and their indications depend on specific clinical characteristics. The present article reviews these indications and also discusses other medications without official approval that have also been used in multiple sclerosis.

[Norovirus outbreaks in geriatric centers: importance of an early detection]

BACKGROUND AND OBJECTIVES

Acute gastroenteritis (AGE) outbreaks of norovirus (NV) occur frequently in nursing homes. Gastrointestinal disorders and degree of dependence of residents complicate early detection and implementation of control measures. Our study's aim was to determine the incidence of NV in elderly care centers, transmission mechanisms and circulating genotypes.

PATIENTS AND METHODS

An epidemiological study of NV outbreaks reported to the Public Health Agency of Barcelona 2010-2012 was performed. The attack rate, outbreak duration, symptomatology and identified NV genotypes were analyzed.

RESULTS

In total, 27 NV outbreaks were reported and 5 (18.5%) occurred in nursing homes (95 cases with lethality of 1.05%). The etiology of one of the five outbreaks could not be confirmed because of late notification. Four of the outbreaks were attributed to person-to-person transmission. The outbreak duration and attack rate among resident person-to-person transmission were significantly higher compared to common exposure transmission. Genotype GII.4 was predominant.

CONCLUSIONS

The identification of critical points and the use of clinical alarm systems could prevent and minimize the spreading and severity of these outbreaks.

[Incidence study of listeriosis in Spain]

We performed a descriptive retrospective study of cases of listeriosis occurring in Spain from 2001 to 2007 to determine the burden and trend of this disease in our setting. Several sources of information were used. Epidemiological information was collected from 1.242 cases of listeriosis, representing a mean incidence rate of 0,56 cases per 100.000 inhabitants per year, which was extrapolated as an overall estimate for Spain. The annual incidence showed a statistically significant increasing trend (p <0,001) over the study period. This figure was higher than that reported in Spain (0,16) by the Microbiological Information System, which is voluntary, showing that underreporting exists. The inclusion of listeriosis in the Mandatory Notification System would allow determination of the distribution and characteristics of this infection in humans, as well as promotion of effective prevention and control.