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Introduction Influenza vaccination is recommended to pregnant women in Spain to reduce the risk of influenza-related complications. Influenza related hospitalizations pose a significant disease burden in children every year. Although children below 6 months are too young to be vaccinated, they can receive protection against influenza through vaccination of their mothers during pregnancy. We estimated the effectiveness of maternal influenza vaccination to prevent influenza hospitalizations in infants under 6 months of age. Methods This is a retrospective pilot study, using data from the Severe Hospitalized Confirmed Influenza Cases (SHCIC) surveillance system in seasons 2017/18 and 2018/19 in Spain. Maternal vaccination status during pregnancy was collected for cases in children 6 months and younger hospitalized with confirmed influenza infection. Influenza vaccine effectiveness was estimated using the screening method, by comparing the proportion of children with vaccinated mothers during pregnancy (proportion of cases vaccinated, PCV), with the vaccination coverage among pregnant women in Spain (proportion of population vaccinated, PPV). Results For all the study period, the PCV was 17% and the PPV was 35%. Influenza vaccination in mothers during pregnancy prevented influenza confirmed hospitalizations in infants aged 6 months and younger with a 61% (95%CI: 27–79%) effectiveness. Conclusions In line with evidence from other countries, influenza vaccination during pregnancy protects infants up to 6 months of age from influenza hospitalizations in Spain. These results support current recommendations of influenza vaccination in pregnant women, and more studies are needed in Spain to confirm the double protection of maternal vaccination in mothers and infants.

SETTING Tuberculosis (TB) control requires accurate knowledge of TB incidence, but few studies have been published on TB incidence using individual data from drug prescriptions. OBJECTIVE To measure the estimated completeness of regional surveillance system data before and after adding data from anti-tuberculosis drug prescriptions. DESIGN We compiled data on all individuals who received specific anti-tuberculosis drugs from three sources-the passive surveillance system, the active surveillance system and the anti-tuberculosis drug prescription database-in the Balearic Islands, Spain, between 2010 and 2012. We applied the capture-recapture method to measure completeness of data reporting. Statistical significance was set at P < 0.05, and 95% confidence intervals (CIs) were calculated. RESULTS We detected 605 incident cases, compared with an estimated incidence of 719 cases (95%CI 646-793), representing 84.1% data completeness. We detected 480 of an estimated 559 pulmonary TB cases (95%CI 501-617; 85.9% data completeness) and 125 of an estimated 161 extra-pulmonary TB cases (95%CI 113-211; 77.6% data completeness). CONCLUSIONS By adding a new source, we increased detection with respect to a previous study by 10.4% for all forms of TB, 9.7% for pulmonary TB and 13% for extra-pulmonary TB.

Introduction In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic. Methods Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin. Results Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended. Conclusions The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.

Fundamentos: La temporada gripal 2009-2010 ha sido más corta y benigna de lo esperado. Desde enero de 2010 los sistemas de vigilancia de gripe indicaban unas tasas de incidencia muy bajas sin detección de circulación del virus. En este contexto, un hospital comunicó una sospecha de brote de enfermedad respiratoria grave, cuya etiología resultó ser gripe (H1N1) 2009. Describimos el brote y las actuaciones de Salud Pública para su control. Métodos: Estudio descriptivo de un brote epidémico por virus gripal pandémico en una residencia para discapacitados mentales. Establecimiento de vigilancia activa. La definición de caso de gripe fue muy sensible para detectar los nuevos casos al inicio, tratarlos precozmente y minimizar la transmisión. Se adoptaron medidas de contención de la infección por virus gripal. Resultados: De 38 casos detectados 7 (todos con factores de riesgo) sufrieron complicaciones graves. No hubo defunciones. La tasa global de ataque fue del 35,2%. Los primeros casos eran trabajadores. Los casos en residentes se acumularon en el pico del brote y entre trabajadores la presentación fue más dispersa. Ninguno de los trabajadores y sólo tres residentes habían sido vacunados. Conclusiones: El brote se inició en los trabajadores de la residencia, a partir de los cuales se difundió a las personas residentes. Destacamos la necesidad de cumplir las recomendaciones de vacunación, no sólo de las personas con factores de riesgo, sino también muy especialmente de los trabajadores en contacto con aquellos.

ResumenSe describe la investigación de un brote de gastroenteritis por norovirus asociado al consumo de ostras. Se encuestaron 346 expuestos (266 afectados). Solamente se enviaron 14 muestras de heces de pacientes al Centro Nacional de Microbiología. Se mandaron ostras recogidas en el lugar de producción al Centro Nacional de Alimentación. Las ostras cumplían los parámetros microbiológicos de calidad aplicables antes de la comercialización, que no incluyen investigación de virus. El análisis epidemiológico asoció la aparición de la enfermedad al consumo de ostras (odds ratio [OR]=60,4; intervalo de confianza del 95% [IC95%]: 26,2-139,3) y de navajas (OR=3,13; IC95%: 1,4-6,9). Los análisis microbiológicos identificaron norovirus en los afectados, pero no en las ostras que habían estado sometidas a un tiempo mayor de depuración que las consumidas. Es necesario un control riguroso de los alimentos de especial riesgo para la transmisión de norovirus y disponer de recursos de laboratorio para investigar brotes alimentarios por norovirus.AbstractWe describe investigation into an outbreak of norovirus gastroenteritis associated with oyster consumption. A survey was conducted in 346 exposed persons, 266 of whom were cases. Only 14 feces samples from patients were sent to the National Microbiology Laboratory. Oysters collected at the production site were sent to the National Food Center. The oysters met the microbiological quality standard required before sale, which did not include virus investigation. Epidemiological analysis showed an association between gastroenteritis and consumption of oysters (OR=60.4; 95% CI: 26.2-139.3) and razor shells (OR=3.13; 95% CI: 1.4-6.9). Microbiological analysis confirmed norovirus in affected individuals but not in the oysters that had been tested after a longer purification period than those consumed. Food with a special risk of norovirus transmission should be strictly monitored. Investigators should dispose of the necessary laboratory resources to study food-borne norovirus outbreaks.

SETTING The Balearic Islands, Spain, 2010-2012. OBJECTIVE To assess the completeness of TB surveillance, and to examine observed and estimated incidence rates (IR) compared with the period 2005-2007. DESIGN The completeness of TB surveillance was assessed using the capture-recapture method. Confidence intervals were calculated using log-linear models. Data sources were records of mandatory notifiable diseases, active hospital surveillance and computerised primary health care history. RESULTS Surveillance completeness for respiratory TB (R-TB) was 99.5%; it was 100% for non-respiratory TB (NR-TB). The overall observed IR was 16.32 cases/100 000 for all types of TB, 3.4 for NR-TB and 12.9 for R-TB. The estimated IR of TB all forms was 16.35/100 000 (95%CI 16.26-16.53), for NR-TB it was 3.4/100 000 (95%CI not calculated) and for R-TB it was 13.0/100 000 (95%CI 12.85-13.12). Surveillance completeness for R-TB during the period 2005-2007 was 65.2%; the observed IR was 22.6/100 000 and the estimated IR 31.3/10 000 (95%CI 25.0-37.7). CONCLUSION The similarity of observed and estimated IR during the period 2010-2012 indicates the validity of the surveillance and the use of improved systems such as electronic medical records in recent years.

The tuberculosis surveillance system in the Balearic Islands was assessed from 2005 to 2007. Applying the capture-recapture method the completeness of this system was evaluated to be 58.4%. When a new electronic recorded data was included in Primary Health Care, up to 66.5% was obtained. This new source of data increased the detected cases of pulmonary tuberculosis from 572 to 681. As a result, the estimated annual incidence rate increases from 18.9 cases/10(5) to 22.6 cases/10(5) [95% CI, 20.9-24.3], similar to figures issued by WHO.

In a background of very low incidence of hepatitis A HA in the last decade (annual average of 1.8 cases per 100,000 inhabitants) we describe an outbreak of HA which evolved in Mallorca between May and August 2010, whose main focus was a nursery school where more cases were parents and other young relatives of the children of the institution. Thirty-four cases were defined as outbreak cases. Ten were children of the nursery or their siblings and 22 adults (3 staff members of the nursery and 19 relatives; median age 33 years). The first detected cases were children of the same class. There were 2 adults with haematological complications, though not severe. All children, nursery staff members, parents, and siblings of the cases of the first affected class were immediately offered HA vaccination, but only 43.3% eligible individuals accepted it. None of the cases had been vaccinated. The outbreak spread mostly from asymptomatic children to young adults, showing the changes in HA pattern. That is of great concern as the risk of severe illness rises with age. This incident shows the need to implement new HA vaccination policies in outbreak control. This was later carried out.

To determine the incidence of acute gastroenteritis in pilgrims on St. James' Way, as well as associated risk factors and microbiological characteristics.Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression.In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/10³ pilgrims-day (95% CI: 18.9-2.4/10³. In the case-control study, the major risk factors were age20 years (OR=4.72; 95% CI: 2.16-10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98-2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91-4.82). The most frequent etiologic agent was norovirus (56%).Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis.

[ES] Conocer la incidencia de gastroenteritis aguda en los peregrinos del Camino de Santiago, los factores de riesgo asociados y su caracterización microbiológica. Se diseñaron dos estudios simultáneos, uno transversal mediante encuestas autocumplimentadas de peregrinos llegados a Santiago y otro de casos y controles a los peregrinos en el camino. Se hizo un análisis multivariado mediante regresión logística. En el estudio transversal la densidad de incidencia fue de 23,5 episodios de gastroenteritis aguda por 1.000 peregrinos-día (intervalo de confianza del 95% [IC95%]: 18,9–29,4/103). En el estudio de casos y controles los factores de mayor riesgo fueron la edad

[ES] Estudio descriptivo de los casos de tuberculosis detectados por el Sistema de Vigilancia Epidemiológicaen Baleares, en el trienio de 2005 a 2007. El objetivo fue caracterizar los casos infradeclarados en términos sociodemográficos y de su contacto con la atención primaria de salud. Globalmente, la infra declaraciónde la tuberculosis se sitúa en torno al 20%. Las características que resultan significativas en el análisis multivariado son la marginalidad social (alcoholismo, usuarios de drogas por vía parenteral o indigencia) (odds ratio ajustada [ORa]:2,6 [1,2-5,3]), el contacto con la atención primaria (ORa:3,2 [1,4-7,1]) y la tuberculosis extrapulmonar (ORa:5,5 [3,2-9,6]). Se recomienda reforzar la notificación de los especialistas hospitalarios mediante la adecuación informática de la historia clínica hospitalaria, y se observa quela información obtenida desde la informatización de la historia en atención primaria resulta de utilidad para mejorar la vigilancia epidemiológica de la tuberculosis. [EN] We performed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance System in the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported cases in sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosis was approximately 20%. Significant factors in multivariate analysis were social marginality (consisting of alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR: 3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengthening notification by hospital specialists through the use of hospital electronic records. Our findings show that the information obtained from the primary care computerized history is helpful in improving the epidemiological surveillance of tuberculosis. Sí