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Introduction: During the influenza vaccination campaign 2011-2012 we established a self-declaration system of adverse events (AEs) in healthcare workers (HCW). The aim of this study is to describe the vaccinated population and analyse vaccination coverage and self-declared AEs after the voluntary flu vaccination in a university hospital in Barcelona., Methods: Observational study. We used the HCW immunization record to calculate the vaccination coverage. We collected AEs using a voluntary, anonymous, self-administered survey during the 2011-2012 flu vaccination campaign. We performed a logistic regression model to determine the associated factors to declare AEs., Results: The influenza vaccination coverage in HCW was 30.5% (n=1,507/4,944). We received completed surveys from 358 vaccinated HCW (23.8% of all vaccinated). We registered AEs in 186 respondents to the survey (52.0% of all respondents). Of these, 75.3% (n=140) reported local symptoms after the flu vaccination, 9.7% (n=18) reported systemic symptoms and 15.1% (n=28) both local and systemic symptoms. No serious AEs were self-reported. Female sex and aged under 35 were both factors associated with declaring AEs., Conclusions: Our self-reporting system did not register serious AEs in HCW, resulting in an opportunity to improve HCW trust in flu vaccination., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Background and Objective: To determine the prevalence of health care workers (HCW) susceptibility to varicella zoster virus (VZV). As a secondary objective, we describe the immunogenicity and reactogenicity of the vaccine., Subjects and Methods: A multicenter analytic cross-sectional study was conducted in 5 hospitals in Catalonia, Spain, in a total of 1,111 HCW, aged between 18-60 years. We studied the prevalence of anti-VZV antibodies (IgG) and obtained demographic, occupational and health related variables that were expected to be associated with immunogenicity, as well as past history of varicella. All susceptible HCW were vaccinated and we studied the immunogenicity (antibody detection) and reactogenicity of the 1st and 2nd doses of the vaccine. Detection of antibodies against VZV was obtained by ELISA. All negative results were confirmed with FAMA., Results: Forty two subjects (3.8%) were negative. Susceptibility to VZV was associated (p<0.05) with decreased age (29.6 years ± 8.5 vs. 32,5 ± 9,3 in non-susceptible individuals), having fewer siblings and having no previous clinical history of varicella. Postvaccination detection tests with ELISA showed a seroconversion rate of 52 and 86% after the 1st and 2nd doses of the vaccine respectively, and 100% when using FAMA. There were no significant adverse events., Conclusions: Susceptibility to varicella among HCW is low. Positive past history of varicella is a good predictor of previous exposure to VZV, since 99% (687/696) of the individuals that declared having experienced the disease were immune. This would avoid prevaccination screening in nearly two thirds of HCW., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background: Patients subject to bone marrow transplantation (BMT) and other blood stem cell transplantations are severely immunocompromised after transplantation. Some studies have suggested that post-transplantation loss of acquired immunity may play a role. The objective of this study was to determine the susceptibility to vaccine-preventable diseases in people subject to BMT and the serologic response after vaccination., Patients and Method: Study population was people subject to transplantation at least 6 months before initiating vaccination and without immunosuppressive treatment at that time. A prevaccination serologic analysis was carried out, and the hepatitis B, the adult tetanus-diphtheria (Td), the IPV, the influenza and the pneumococccal vaccines were administered in accordance with standard guidelines Depending on the immune status of the patient according to the serologic analysis, the MMR vaccine was administered no sooner than 18 months after transplantation. After vaccination, a serologic analysis was carried out to determine the response., Results: The mean time SD between transplant and the initiation of vaccination was 3.2 2.9 years. Of the 122 recipients of BMT (average age 35.8 13 years; 54.2% male), 51.7% received an allogenic and 48.3% an autologous transplant. Before vaccination, the susceptibility was 48.2% for tetanus, 66.7% for diphtheria, 74.1% for pertussis, 85.9% for hepatitis B, 13.4% for measles, 36.7% for rubella and 9.2% for mumps. The rates of seroconversion with protective titers after vaccination for tetanus, diphtheria and hepatitis B were 94%, 67% and 75% respectively. The response to the MMR vaccine was greater than 70%, with a second dose of the vaccine being needed in 26% of patients., Conclusions: Susceptibility to vaccine-preventable diseases in transplanted patients is high. The acceptable response to vaccination justifies the development of specific programs. Given the special characteristics of this group of patients, vaccination programs must be simple and flexible.

Background: Impact of hospital admissions for pneumonia during 1998 in the Hospital Clínic, Barcelona., Patients and Method: Retrospective information on the hospitalizations for pneumonia was collected., Results: During 1998 a total of 626 adult were admitted with a hospital diagnosis of pneumonia (72% were >/= 65 years). The average length of stay was 10 days. Half of these patients were previously hospitalized during the preceding 5 years., Conclusions: Hospital admissions due to pneumonia (17 cases per 1.000 hospitalizations) accounted for an estimated cost of 2.3% of the cost of all the hospitalized patients.

Background: To evaluate the usefulness of the Appropriateness Evaluation Protocol (AEP) for assessing the extra length of stay attributable to nosocomial bacteremia., Patients and Methods: Retrospective review of the medical records (1989, 1990 and 1991) of all patients, who developed Staphylococcus aureus nosocomial bacteremia. Evaluation of hospital stay was performed using the AEP. Calculation of the kappa index and intraclass correlation coefficient., Results: A total of 158 patients were included S. aureus nosocomial bacteremia is responsible for a mean excess length of stay of 4.3 days per patient. Kappa index for the method used was 76%, and intraclass correlation coefficient was 61%., Conclusions: The AEP has been shown to be a reliable tool for assessing the extra days of stay attributable to nosocomial bacteremia in the Spanish National Health System. The use of AEP should be extended to assess the extra stay attributable to other types of nosocomial infections.

Background: Seroepidemiologic studies carried out in different European countries have shown the existence of low levels of protection against diphtheria. In this study the prevalence of antidiphtheria antibodies in the adult population of Catalonia, Spain, during 1995 has been studied., Patients and Methods: The prevalence of the seroprotection against diphtheria was investigated in a representative sample (n = 1,248) of the adult population of Catalonia aged 15 or older. The antibody levels were determined by means of the in vitro Vero-cell neutralization technique. Two protection levels were considered: 0.01-0.09 U/ml (partial immunity) and > or = 0.1 U/ml (total immunity)., Results: The prevalence of absolute seroprotection was 12.4% (CI 95%: 10.5-14.3%) and that of partial and absolute seroprotection was 26.0% (CI 95%: 23.6-28.4%). The prevalence of antibodies is higher in men than in women (29.2% versus 23.1%; p < 0.05), and in urban than in rural environments (27.2% versus 19.9%: p < 0.05). The odds ratios adjusted by multiple logistic regression analysis were 1.43 (1.11-1.85) and 1.56 (1.05-2.29), respectively., Conclusion: The prevalence of antidiphtheria antibodies in the adult population of Catalonia, Spain, is low. The results suggest the need to develop antidiphtheria vaccination programmes in the adult population.

Background: To know current hepatitis B (HBV) and hepatitis A (HAV) infection status among a group of health sciences students during 1990-1993 period., Subjects: 1,734 health sciences students during 1990-1991, 1992-1993 and 1993-1994 academic years., Main Outcome Measures: demographic variables, vaccination history against HAV and HBV viruses, anti-HBc and anti-HAV antibody titres (ELISA kits)., Results: 1,734 subjects aged 22.5 +/- 2.9 years (75% women) were included. Anti-HBc total cumulated prevalence during the three year period was 2.5% (CI 95%, 1.9%-3.4%). Anti-HAV total cumulated prevalence during the three year period was 13.9% (CI 95%: 11.4%-16.8%). No statistical significant association between antibody prevalence and both age sex was found., Conclusions: Low prevalence, and thus, high susceptibility to HBV and HAV infection was found. We stress the importance of systematic vaccination among health sciences students not previously engaged in universal vaccination programmes. We also point out the need for further analysis upon the utility of combined HB/HA vaccine as an alternative to antihepatitis B universal vaccination programmes among adolescent cohorts.

Background: The aim of this study was to know the prevalence of antibodies against measles, rubella and parotiditis in young adults., Methods: The study was carried out in health care students during the academic year of 1992-1993. Demographic and geographic variables were obtained as were vaccination and history of diseases. Antibodies against measles, rubella, and parotiditis were determined by ELISA techniques with commercial reagents., Results: Three hundred and six individuals of 21.3 +/- 2.2 years (range 17-36 years) with 27.5% being males were studied. Past history of measles, rubella and parotiditis was reported in 43.5, 30.7 and 37.3%, respectively, with vaccination being 23.2, 43.8 and 20.6%, respectively. The prevalence of antibodies was 93.1% (measles), 96.4% (rubella) and 92.1% (parotiditis)., Conclusions: The prevalence of infection of measles, rubella and parotiditis in the young population studied is mainly due to infection by wild type virus. The foreseeable growth of susceptibility groups in this population which should be adequately evaluated by extensive seroepidemiologic questionnaires, favors the appearance of epidemic outbreaks. The use of the triple viral vaccine is suggested as an alternative to rubella vaccination in presumable susceptible young women.

Background: The convenience of carrying out prevaccination detection studies of hepatitis A virus (HAV) markers depends on the relative costs of the detection and vaccination, as well as the prevalence of susceptible subjects in each population group to be vaccinated. The aim of this study was to analyze the efficacy of the systematic prevaccination detection of anti-HAV antibodies in Catalonia, Spain., Methods: The following formula was applied: Unit cost of detection + (1-X) x Unit cost of vaccination of anti-HAV negative subjects = group vaccination cost, with X being the threshold of prevalence of marker under which detection no longer remains efficient. This prevalence was compared with the findings of a seroepidemiologic survey carried out in international travellers and food handlers., Results: The unit cost of the detection of anti-HAV was calculated as 2,733 pesetas, and the unit cost of the vaccination as 9,963 pesetas obtaining a prevalence anti-HAV threshold of 27%. This prevalence corresponds to travellers under the age of 30 years and food handlers under the age of 25 years., Conclusions: The systematic detection of anti-HAV is only recommended in population groups in which prevalences higher than 27% may be expected. The vaccination is more efficient without a previous marker study under this threshold. According to this study, direct vaccination of food handlers under the age of 25 years (born after 1969) is recommended as is that of international travellers under the age of 30 years (born after 1964). In those over the age of these collectives, the prevaccination study is more efficient.

Background: The prison population represents a high risk group for the human immunodeficiency virus type 1 infection. The present study was carried out to know the prevalence of infection in this collective in three penitentiary centers in Catalonia., Methods: All the subjects who were in or who were admitted to the three penitentiaries for men from October 1987 to April 1988 were included in the study (n = 1,579). Demographic risk factor and penitentiary variables were obtained. The determination of anti-HIV-1 antibodies was performed by enzymoimmunoanalysis (Dupont HIV ELISA)., Results: The global prevalence of HIV-1 infection was of 40.6%. Significant statistical differences were found among intravenous drug users (IVDU) and non IVDU (chi 2 = 376.8, p < 0.0001, OR = 9.6, CI 95% = 7.5 - 12.3) and between habitual and sporadic users (chi 2 = 23.9, p < 0.0001, OR = 3.0, CI 95% = 1.9 x 4.7)., Conclusions: The penitentiary population in Catalonia is a collective with a high prevalence of infection by the human immunodeficiency virus type 1, with intravenous drug use being the fundamental factor associated to this prevalence.

Background: Vaccination against the hepatitis B virus (HBV) of health care staff during their studies would have the advantage of early prevention when the prevalence of infection is presumably low., Methods: The population to be protected is made up of 1533 medical and nursing students. In those who accepted, anti-HBc was determined and information was obtained concerning circumstances of exposure to HBV. Vaccination was offered to all the cases of negative anti-HBc. Individuals receiving 3 doses of the vaccination (20 micrograms at 0, 1 and 6 months) were seen at 4-7 months of the last dose to determine the anti-HBs titers achieved., Results: One thousand sixty-five students (70%) accepted inclusion into the prevaccination anti-HBc study and 1,029 (3.4%) were anti-HBc negative. Only older age and previous transfusions and jaundice were significantly associated to greater prevalence of infection by HBV. The adherence to 1, 2 or 3 doses of the vaccination was 96%, 94% and 87%, respectively. Following the 3 doses, > or = 10 UI/I of anti-HBs were detected in 97% of the cases studied with geometric measurement of the responders being 1580 U/I. The titer had an inverse relation which was not significant with age., Conclusions: The high participation in the program of anti-hepatitis B vaccination and the excellent immune response observed leads to the recommendation of systemic vaccination to future health care professionals during their study period. Furthermore, the low prevalence of previous HBV infection advises against previous detection of anti-HBc with immunization of the whole collective being more effective.

Background: A high percentage of current hospital visits are made by the elderly. The aim of this work is to quantify the risk of contracting a nosocomial infection among elderly patients admitted to a university hospital., Methods: From the patients admitted from the emergency unit, outpatients and the waiting list, 6 patients of different age groups were chosen each day by a simple random sampling. The criteria of nosocomial infection were those of the CDC. The analysis of the information was made with the programme EPIINFO version 5. The chi 2 tests and Fisher's exact test were used to compare proportions., Results: The rate of nosocomial infection in the group aged over 64 was 14.8%, showing statistically significant differences with respect to other age groups (p = 0.001). In this group the predominant infection was urinary, with an odds-ratio of 3.69, in comparison with the 25 to 44 age group. A prolonged hospital stay (> 15 days) has proved to be closely related to the risk of nosocomial infection in all age groups (p < 0.0001) in patients over 64., Conclusions: The greater risk of contracting nosocomial infections in the elderly makes it advisable to develop specific prevention programmes for this group, and the fitness of accommodations the length of stay to the care needs suitable to the hospital level.

Background: The convenience of carrying out pre-vaccination screening of VHB markers depends on the relative costs of screening and vaccination and also on the prevalence of susceptible subjects in each group of the population. The aim of the present work was to analyse the efficiency of pre-vaccination screening of antiHBc in Catalonia in 1991., Methods: The per-unit cost of screening was calculated at 1366 ptas. The formula applied was: cost per-unit of screening + (1-X) x the cost per-unit of vaccination of anti-HBc (-) = cost of vaccinating the group. "X" being the threshold of prevalence of markers below which screening cases to be efficient. This prevalence is compared with those expected in the groups of the population to be vaccinated., Results: By applying the above-mention ned formula and taking into account costs in time and travel of the people to be vaccinated, a prevalence threshold of 23% is obtained. This prevalence is much higher than that found in adolescents and students of medicine and nursing, similar to that found in health professionals and lower than that of other risk groups., Conclusions: Systematic screening of anti-HBc is only recommended in groups of the population where a prevalence higher than 20-25% can be expected. Below this threshold vaccination without previous study of markers is more efficient. This enormously simplifies the strategies of universal vaccination of children, adolescents or both.

The prevalence of infection by hepatitis B (HBV) and delta (HDV) viruses and presumably related variables were evaluated in a prison for young male convicts, aged 16-21 years (n = 686), 55.1% of convicts were positive for one or more VHB markers, and 7.1% were positive for HBsAg; 89.7% of these were negative for IgM anti-HBc (chronic carriers), while 36.6% were positive for HBeAg. Anti-delta antibodies were detected in 37.5% of chronic carriers. The seropositivity of HVB markers was much higher in parenteral drug abusers (PDA) as compared with non PDA (76.3% vs 26.7%, p less than 0.0000001, OR = 8.82). Among PDA, it was higher in regular users than in occasional ones (83.3% vs 62.9%, p = 0.0001, OR = 2.95) and in those who had acquired the habit at an early age (p = 0.035). The stratified analysis also showed an association of VHB infection with other variables, basically ethical and prison-related. The possibility to develop active immunization programs is evaluated.