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Between 2014 and 2018, we evaluated the severity of 687 cases of bronchiolitis caused by respiratory syncytial virus (RSV) in Catalonia, Spain. Compared to RSV-B, RSV-A cases required intensive care (adjusted relative risk (aRR) = 1.44, p < 0.01) and respiratory support (aRR = 1.07, p < 0.01) more often; hospital stay was one day longer (p < 0.01). Subgroup identification may aid clinical evaluation and seasonal healthcare planning.

Background Bronchiolitis caused by the respiratory syncytial virus (RSV) is the main reason for hospitalization in infants. Supportive care is the mainstay of treatment, and tests are restricted to a few indications. During 2015, our hospital bronchiolitis protocol (2015 HBP) was updated according to the latest practice guidelines. Objective The objective of this study was to assess implementation of the 2015 HBP and the clinical outcome of children aged

COVID-19-vaccination; Adverse reactions; Booster dose Vacunación de COVID-19; Reacciones adversas; Dosis de refuerzo Vacunació de COVID-19; Reaccions adverses; Dosi de reforç The objective of this study was to assess the local and systemic adverse reactions after the administration of a COVID-19 mRNA-1273 booster between December 2021 and February 2022 by comparing the type of mRNA vaccine used as primary series (mRNA-1273 or BNT162b2) and homologous versus heterologous booster in health care workers (HCW). A cross-sectional study was performed in HCW at a tertiary hospital in Barcelona, Spain. A total of 17% of booster recipients responded to the questionnaire. The frequency of reactogenicity after the mRNA-1273 booster (88.5%) was similar to the mRNA-1273 primary doses (85.8%), and higher than the BNT162b2 primary doses (71.1%). The reactogenicity was similar after receiving a heterologous booster compared to a homologous booster (88.0% vs. 90.2%, p = 0.3), and no statistically significant differences were identified in any local or systemic reactions. A higher frequency of medical leave was identified in the homologous booster dose group vs. the heterologous booster dose group (AOR 1.45; 95% CI: 1.00–2.07; p = 0.045). Our findings could be helpful in improving vaccine confidence toward heterologous combinations in the general population and in health care workers.

The aim of this study was to assess adverse reactions to COVID-19 vaccines, comparing the BNT162b2 or the mRNA-1273 COVID-19 vaccines and the presence and seriousness of a previous COVID-19 infection. We conducted a cross-sectional online survey of vaccinated healthcare workers at a tertiary hospital in Barcelona (Spain). Thirty-eight percent of vaccine recipients responded to the questionnaire. We compared the prevalence of adverse reactions by vaccine type and history of COVID-19 infections. A total of 2373 respondents had received the BNT162b2 vaccine, and 506 the mRNA-1273 vaccine. The prevalence of at least one adverse reaction with doses 1 and 2 was 41% and 70%, respectively, in the BNT162b2 group, and 60% and 92% in the mRNA-1273 group (p < 0.001). The BNT162b2 group reported less prevalence of all adverse reactions. Need for medical leave was significantly more frequent among the mRNA-1273 group (12% versus 4.6% p < 0.001). Interestingly, respondents with a history of allergies or chronic illnesses did not report more adverse reactions. The frequency of adverse reactions with dose 2 was 96% (95% CI 88–100%) for those with a history of COVID-19 related hospitalization, and 86% (95% CI 83–89%) for those with mild or moderate symptomatic COVID-19, significantly higher than for participants with no history of COVID-19 infections (67%, 95% CI 65–69%). Our results could help inform vaccine recipients of the probability of their having adverse reactions to COVID-19 vaccines.

The DRIVE project aims to establish a sustainable network to estimate brand-specific influenza vaccine effectiveness (IVE) annually. DRIVE is a public-private partnership launched in response to EMA guidance that requires effectiveness evaluation from manufacturers for all individual influenza vaccine brands every season. IVE studies are conducted by public partners in DRIVE. Private partners (vaccine manufacturers from the European Federation of Pharmaceutical Industries and Association (EFPIA)) provide written feedback moderated by an independent scientific committee. Test-negative design (TND) case-control studies (4 in primary care and five in hospital) were conducted in six countries in Europe during the 2018/19 season. Site-specific confounder-adjusted vaccine effectiveness (VE) estimates for any vaccine exposure were calculated by age group (18 years (y), 18-64y and 65 + y) and pooled by setting (primary care, hospital) through random effects meta-analysis. In addition, one population-based cohort study was conducted in Finland. TND studies included 3339 cases and 6012 controls; seven vaccine brands were reported. For ages 65 + y, pooled VE against any influenza strain was estimated at 27% (95%CI 6-44) in hospital setting. Sample size was insufficient for meaningful IVE estimates in other age groups, in the primary care setting, or by vaccine brand. The population-based cohort study included 274,077 vaccinated and 494,337 unvaccinated person-years, two vaccine brands were reported. Brand-specific IVE was estimated for Fluenz Tetra (36% [95%CI 24-45]) for ages 2-6y, Vaxigrip Tetra (54% [43-62]) for ages 6 months to 6y, and Vaxigrip Tetra (30% [25-35]) for ages 65 + y. The results presented are from the second influenza season covered by the DRIVE network. While sample size from the pooled TND studies was still too low for precise (brand-specific) IVE estimates, the network has approximately doubled in size compared to the pilot season. Taking measures to increase sample size is an important focus of DRIVE for the coming years.

Aim: Human respiratory syncytial virus (HRSV) is the main cause of respiratory tract infections among infants. Materials & methods: In the present study, the molecular epidemiology of HRSV detected from 2013 to 2017 has been described. Results: A 10% of collected samples were laboratory confirmed for HRSV. Patients under 2 years of age were the main susceptible population to respiratory syncytial virus disease, but an increasingly number of confirmed patients over 65 years of age was reported. Epidemics usually started in autumn and ended in spring. Both HRSV groups co-circulated every season, but the HRSV-B was the most predominant. HRSV-A and HRSV-B strains mainly belonged to ON1 and BA9 genotypes, respectively. Conclusion: The present study reports recent data about the genetic diversity of circulating HRSV in Spain.

Highlights • There were shifts in the predominance of influenza types or subtypes. • Drifted A(H3N2) strains circulated during the 2014–2015 season and a higher hospitalisation rate was reported. • Circulation of B/Vic-like viruses not included in the trivalent vaccine during the 2015–2016 season. • Virulence and resistance mutations were detected due to an enhanced surveillance. • Virological surveillance should be strengthened in hospital settings., Background Influenza viruses (FLUV) are continuously evolving, which explain the occurrence of seasonal influenza epidemics and the need to review the vaccine strain composition annually. The aim is to describe the genetic diversity and clinical outcomes of FLUV detected at a tertiary university hospital in Barcelona (Spain) during the 2012–2016 seasons. Methods The detection of FLUV from patients attended at the Emergency Department or admitted to the hospital was performed by either immunofluorescence or PCR-based assays. A specific real-time one-step multiplex RT-PCR was performed for influenza A (FLUAV) subtyping. The complete coding haemagglutinin domain 1 (HA1) and neuraminidase (NA) (2015–2016) protein sequences from a representative sampling were molecular characterised. Results A total 1774 (66.1%) FLUAV and 910 (33.9%) influenza B (FLUBV) cases were laboratory-confirmed. The hospitalisation rate was different between seasons, being the highest (81.4%) during the 2014–2015 season. FLUV were genetically close to vaccine strains except to the 2014–2015, in which most characterised A(H3N2) viruses belonged to a genetic group different from the vaccine strain. During the 2015–2016 season, B/Victoria-like viruses were the most predominant, but this component was not included in the trivalent vaccine used. Mutations D222G or D222N in HA1-domain were found in 3 A(H1N1)pdm09 strains from ICU-admitted cases. Three A(H1N1)pdm09 strains carried the NA H275Y (2) and S247N (1) mutations, respectively related to resistance or decreased susceptibility to oseltamivir. Conclusions The circulation of drifted A(H3N2) strains during the 2014–2015 season was related to the high hospitalisation rate due to the mismatch with the vaccine strains. The predominance of a FLUBV lineage not included in the trivalent influenza vaccine during the 2015–2016 season highlights the need to use a tetravalent influenza vaccine. Virological surveillance of viral variants carrying protein changes that alter tropism and susceptibility to antivirals features should be strengthened in hospital settings.

Aim: To describe the genetic diversity of rhinovirus (RV) from patients attended at a tertiary hospital in Barcelona (Spain) from October 2014 to May 2017. Methods: RV detection was performed by real-time multiplex RT-PCR. A specific real-time quantitive retrotranscription PCR (qRT-PCR) was carried out to select those samples (Ct

AIM To describe the prevalence, clinical characteristics and risk factors of opportunistic infection (OI) in a cohort of patients with inflammatory myopathies, and compare mortality rates between those with and without OIs. METHODS In total, 204 patients from our myositis cohort were reviewed to identify patients who had experienced an OI during the period 1986-2014. The patients' clinical characteristics, treatments received, and outcomes were systematically recorded. Disease activity at the OI diagnosis and the cumulative doses of immunosuppressive drugs were analyzed, as well as the specific pathogens involved and affected organs. RESULTS The prevalence of OI in the total cohort was 6.4%: viruses, 44.4% (varicella-zoster virus, cytomegalovirus); bacteria, 22.2% (Salmonella sp., Mycobacterium tuberculosis, M. chelonae); fungi, 16.7% (Candida albicans, Pneumocystis jirovecii); and parasites, 16.7% (Toxoplasmosis gondii, Leishmania spp.). Lung and skin/soft tissues were the organs most commonly affected (27.8%). Overall, 55.6% of OIs developed during the first year after the myositis diagnosis and OI was significantly associated with administration of high-dose glucocorticoids (P = 0.0148). Fever at onset of myositis (P = 0.0317), biological therapy (P

Background and Aim The vaccination against hepatitis B virus (HBV) is recommended in patients with inflammatory bowel disease (IBD). However, the response to this vaccine seems to be lower in IBD patients than in the general population. This study aims to evaluate the immunogenicity of the HBV vaccine in a cohort of patients with IBD, to associate factors with the response and to analyze the effects of a second schedule vaccination. Methods We conducted a retrospective cohort study of adults with IBD, susceptible to HBV infection. All patients received a three-dose standard schedule of HBV vaccine. Non-responders were revaccinated with a second three-dose standard schedule. Adequate immunity to HBV was defined as antibodies against hepatitis B surface antigen (anti-HBs) ≥ 10 mIU/mL. Age, comorbidities, treatment, and other variables were collected. Results One hundred seventy-two patients were included and received the first HBV vaccine schedule. Eighty-seven developed anti-HBs ≥ 10 mIU/mL (50.6%; 95% confidence interval [CI]: 42.9–58.3). From the non-responders, 53 were revaccinated and 28 showed an adequate serological response (52.8%; 95% CI: 38.6–66.7). Age older than 55 years (OR: 3.6; 95% CI: 1.3–10.2) and comorbidities (OR: 2.8; 95% CI: 1.1–7.1) were associated with suboptimal response. In the multivariate analysis, only age was a predictor of non-response (age higher than 55 years; OR: 3.9; 95% CI: 1.3–11.9) Conclusion The response rate to the HBV vaccine is lower in patients with IBD compared with the general population, especially in those older than 55 years. Revaccination improved response rate by 50%.

Resumen Introduccion La tos ferina ha aumentado su incidencia en los ultimos anos en paises con elevadas coberturas de vacunacion. El objetivo del estudio ha sido conocer el impacto sanitario de la tos ferina en Espana en el periodo 1997-2011 en relacion con hospitalizaciones, la mortalidad y los costes asociados. Metodos Se analizaron de forma retrospectiva las altas hospitalarias incluidas en el Conjunto Minimo Basico de Datos (CMBD) en Espana del periodo 1997-2011, con diagnostico principal o secundarios relacionados con tos ferina. Se calcularon las tasas de incidencia de hospitalizacion por tos ferina (por 100.000 habitantes) por ano, por grupo de edad y por comunidad autonoma, asi como las tasas de mortalidad y de letalidad. Resultados Entre 1997 y 2011 se registraron en Espana 8.331 altas hospitalarias con diagnostico de tos ferina. La incidencia global de hospitalizaciones por tos ferina fue de 1,3 casos por 100.000 habitantes. El 92% de las hospitalizaciones correspondieron a ninos menores de un ano de edad, con una incidencia de 115,2 hospitalizaciones por 100.000 nacidos. Se registraron 47 defunciones, 37 (79%) en el grupo de menores de un ano y 6 (13%) en el grupo de mayores de 65 anos. El coste estimado de una hospitalizacion por tos ferina fue de 1.841 euros. Conclusion La epidemiologia de los casos graves de tos ferina y su impacto clinico y economico confirman la necesidad de modificar las estrategias de vacunacion en Espana para lograr un control mas efectivo en los grupos mas vulnerables.

Resumen Fundamento y objetivo La tos ferina sigue siendo una importante causa de morbimortalidad a pesar de las actuales estrategias vacunales. Se diseno este estudio para describir los resultados y las caracteristicas de los contactos estrechos de casos de tos ferina diagnosticados en menores de 16 anos en un hospital de tercer nivel de Barcelona. Pacientes y metodo Estudio transversal. Los datos se recogieron a partir de las historias clinicas de los contactos de los casos pediatricos diagnosticados de tos ferina en el Hospital Universitario Vall d’Hebron de 2005 a 2009. Se incluyeron solo pacientes con estudio microbiologico realizado. Se calculo la odds ratio (OR) con su intervalo de confianza del 95% (IC 95%) como medida de asociacion. Resultados Fueron estudiados 91 casos indice y 404 contactos. La prevalencia de casos positivos entre los contactos fue del 33,2%. Los contactos de los casos indice menores de 6 meses presentaron mas riesgo de ser positivos que los contactos de los ninos mayores (OR 3,38; IC 95% 1,88-6,10). Se identificaron como casos primarios el 16,7% de los contactos estudiados. Estos representaron la fuente de contagio para el 67,7% de los casos indice menores de 6 meses y para el 26,9% de los ninos mayores. Conclusiones El estudio de contactos de casos pediatricos de tos ferina es una actividad clinica necesaria. Es mas probable hallar casos primarios en el estudio de contactos de ninos menores de 6 meses. Las estrategias preventivas deben ir dirigidas fundamentalmente a los contactos frecuentes de este grupo.

Resumen Fundamento y objetivo El embarazo es un factor de riesgo independiente para presentar una forma clinica grave de gripe. Multiples organismos nacionales e internacionales incluyen en sus recomendaciones oficiales la administracion de vacunacion antigripal a gestantes. El objetivo de este trabajo fue estimar las coberturas de vacunacion antigripal en una muestra amplia de mujeres atendidas por parto en un hospital de tercer nivel y conocer los conocimientos y practicas de los obstetras en relacion con la indicacion de la vacuna. Metodos Estudio descriptivo transversal mediante 2 encuestas: una administrada a las puerperas atendidas por parto entre diciembre de 2007 y febrero de 2008, y otra dirigida a los obstetras que trabajaban en este hospital o en centros de atencion primaria del area de referencia. Resultados La cobertura vacunal en las puerperas del estudio fue de un 4,1%. El 80,5% de las mujeres no presentaba comorbilidad asociada. La cobertura vacunal en el grupo con comorbilidad fue del 3,3%. El profesional que recomendo mas frecuentemente la vacuna fue la comadrona (28,9%) y la enfermera (18,4%). Entre los obstetras, solo el 20% conocia la indicacion de la vacunacion antigripal en gestantes durante el primer trimestre, y el 65,1%, en el segundo o tercer trimestre. Solo el 7% manifesto prescribir la vacuna en el primer trimestre y un 20,9%, en el segundo o tercer trimestre. Conclusiones La cobertura vacunal en las gestantes de nuestro estudio es muy baja. Los obstetras encuestados presentaron un bajo nivel de conocimiento de las recomendaciones vigentes, en especial la de la inmunizacion durante el primer trimestre del embarazo, y muy pocos la prescriben.

Primary cutaneous aspergillosis is rare in premature infants. It requires combined medical and surgical strategies. Liposomal amphotericin B is recommended as first-line therapy, but salvage regimens with others antifungal agents, such as voriconazole, have been reported. Voriconazole's pharmacodynamics is unknown in this population. We report a case of severe toxicity to voriconazole in a preterm patient with primary cutaneous aspergillosis.

The vaccination against hepatitis B virus (HBV) is recommended in patients with inflammatory bowel disease (IBD). However, the response to this vaccine seems to be lower in IBD patients than in the general population. This study aims to evaluate the immunogenicity of the HBV vaccine in a cohort of patients with IBD, to associate factors with the response and to analyze the effects of a second schedule vaccination.We conducted a retrospective cohort study of adults with IBD, susceptible to HBV infection. All patients received a three-dose standard schedule of HBV vaccine. Non-responders were revaccinated with a second three-dose standard schedule. Adequate immunity to HBV was defined as antibodies against hepatitis B surface antigen (anti-HBs) ≥ 10 mIU/mL. Age, comorbidities, treatment, and other variables were collected.One hundred seventy-two patients were included and received the first HBV vaccine schedule. Eighty-seven developed anti-HBs ≥ 10 mIU/mL (50.6%; 95% confidence interval [CI]: 42.9-58.3). From the non-responders, 53 were revaccinated and 28 showed an adequate serological response (52.8%; 95% CI: 38.6-66.7). Age older than 55 years (OR: 3.6; 95% CI: 1.3-10.2) and comorbidities (OR: 2.8; 95% CI: 1.1-7.1) were associated with suboptimal response. In the multivariate analysis, only age was a predictor of non-response (age higher than 55 years; OR: 3.9; 95% CI: 1.3-11.9) CONCLUSION: The response rate to the HBV vaccine is lower in patients with IBD compared with the general population, especially in those older than 55 years. Revaccination improved response rate by 50%.

Pertussis incidence has increased in recent years in countries with high vaccination coverage. The aim of this study was to determine the health impact of pertussis in Spain in the period 1997-2011 in relation to hospitalizations, mortality, and associated costs.We retrospectively analyzed hospital discharges included in the Minimum Data Set (MDS) in Spain for the period 1997-2011, with a primary or secondary diagnosis related to pertussis. We calculated incidence rates of hospitalization for pertussis (per 100,000) per year, by age group and by Autonomous Region, along with the mortality and lethality rates.A total of 8,331 hospital discharges with a diagnosis of pertussis were recorded in Spain between 1997 and 2011. The overall incidence of pertussis hospitalizations was 1.3 cases per 100,000 inhabitants. The large majority (92%) of hospitalizations occurred in children under one year of age, with an incidence of 115.2 hospitalizations per 100,000. There were 47 deaths, 37 (79%) in the group of children under 1 year and 6 (13%) in the group older than 65 years. The estimated cost of hospitalization for pertussis was 1,841 euros.The epidemiology of severe cases of pertussis, and its clinical and economic impact, confirms the need to modify the vaccination strategies for Spain to achieve more effective control in the most vulnerable groups.

Pertussis remains an important cause of morbimortality despite current vaccination strategies. This study was designed to describe the results and characteristics of close contacts of pertussis cases diagnosed in children less than 16 years in a tertiary hospital in Barcelona.Cross-sectional study. Data were collected from chart review of contacts of paediatric cases of pertussis in Vall d'Hebron University Hospital from 2005 to 2009. Only patients with microbiological study done were included. The odds ratio (OR) and 95% confidence interval (95% CI) were calculated as association measure.Ninety-one index cases and 404 contacts were studied. The prevalence of positive cases among contacts was 33.2%. Contacts of index cases younger than 6 months had a higher risk of being positive for pertussis than contacts of older children (OR: 3.38; 95% CI: 1.88-6.10). Primary cases were identified as 16.7% of the contacts studied, who were the source of infection for 67.7% of index cases younger than 6 months and for 26.9% of older index cases.Contact tracing of paediatric pertussis cases is a necessary clinical activity. It is more likely to find primary cases in the contact investigation of children less than 6 months. Preventive strategies should be targeted primarily to frequent contacts of this age group.