Browsing by Author "Masa-Calles, Josefa"
Now showing 1 - 20 of 42
Results Per Page
Sort Options
Publication Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years' experience, Spain, 1998 to 2015(European Centre for Disease Prevention and Control (ECDC), 2018) Masa-Calles, Josefa; Torner, Núria; Lopez-Perea, Noemi; Torres-de Mier, Maria de Viarce; Fernandez Martinez, Beatriz; Cabrerizo, Maria; Gallardo-García, Virtudes; Malo, Carmen; Margolles, Mario; Portell, Margarita; Abadía, Natividad; Blasco, Aniceto; García-Hernández, Sara; Marcos, Henar; Rabella, Núria; Marín, Celia; Fuentes, Amelia; Losada, Isabel; Gutiérrez, Juan García; Nieto, Alba; García Ortúzar, Visitación; Garcia-Cenoz, Manuel; Arteagoitia, José María; Blanco Martínez, Ángela; Rivas, Ana; Castrillejo, DanielAcute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000-0.78/100,000). Two periods (P) are described: P1 (1998-2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007-2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain-Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.Publication An imported case of vaccine-derived poliovirus type 2, Spain in the context of the ongoing polio Public Health Emergency of International Concern, September 2021(European Centre for Disease Prevention and Control (ECDC), 2021-12) Chirlaque López, María Dolores; Cabrerizo, Maria; Guzmán Herrador, Bernardo R; Masa-Calles, Josefa; Alarcón-Linares, María Ester; Allende, Ana; Aznar Cano, Esteban; Barranco Boada, María Isabel; Cantero Gudino, Elena; Fernández-Balbuena, Sonia; Fernández Dueñas, Ana; Fernández-García, María Dolores; García Hernández, Laura; García Ortúzar, Visitación; Lopez-Perea, Noemi; Martínez-Salcedo, Eduardo; Moreno-Docón, Antonio; Ordobás Gavín, María; Rodero Garduño, Inmaculada; Sierra Moros, Maria José; Simón Soria, Fernando; Limia Sánchez, Aurora; Suárez Rodríguez, BertaThe monthly retrospective search for unreported acute flaccid paralysis (AFP) cases conducted as a complementary component of the Spanish AFP surveillance system identified a case of AFP in a child admitted in Spain from Senegal during August 2021. Vaccine-derived poliovirus 2 was identified in the stool in September 2021. We present public health implications and response undertaken within the framework of the National Action Plan for Polio Eradication and the Public Health Emergency of International Concern.Publication An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018(European Centre for Disease Prevention and Control (ECDC), 2023-04) Pampaka, Despina; Lopez-Perea, Noemi; Fernandez-Garcia, Aurora; Huertas-Zarco, Isabel; Castellanos-Martínez, Maite; Villatoro-Bongiorno, Katja; Roig-Sena, Javier; Torner, Nuria; Mar Mosquera, María; Echevarria, Juan Emilio; Ferras Prats, Joaquim; Masa-Calles, Josefa; Instituto de Salud Carlos IIIGiven sustained high vaccination coverage and enhanced surveillance for measles, Spain has been free of endemic measles transmission since 2014, achieving elimination certification from the World Health Organization in 2017. In November 2017, measles was introduced through an imported case travelling to the Valencian Community, causing an interregional outbreak. Here, we describe the outbreak using data reported to the national epidemiological surveillance network. The outbreak involved 154 cases (67 males, 87 females) notified in four regions; 148 were laboratory-confirmed and six epidemiologically linked. Most cases were adults aged 30-39 (n = 62, 40.3%) years. Sixty-two cases were hospitalised (40.3%) and 35 presented complications (22.7%). Two thirds of the cases (n = 102) were unvaccinated including 11 infants (≤ 1 year) not yet eligible for vaccination. The main route of transmission was nosocomial; at least six healthcare facilities and 41 healthcare workers and support personnel were affected. Sequencing of the viral nucleoprotein C-terminus (N450) identified genotype B3, belonging to the circulating MVs/Dublin.IRL/8.16-variant. Control measures were implemented, and the outbreak was contained in July 2018. The outbreak highlighted that raising awareness about measles and improving the vaccination coverage in under-vaccinated subgroups and personnel of healthcare facilities are key measures for prevention of future outbreaks.Publication Análisis de la evolución de la tos ferina en España, 2005-2020. Impacto de la vacunación en gestantes sobre la epidemiología de la tos ferina(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2022-08-28) Luna-Porta, Belen; Garzón Sánchez, Ana; Lopez-Perea, Noemi; Soler Soneira, Marta; Masa-Calles, Josefa[ES] En la última década la tos ferina ha experimentado un resurgimiento en muchas zonas del mundo, incluidos los países con altas coberturas de vacunación. Entre las razones que explican esta reemergencia están la evanescencia de la protección que confiere las vacunas de tos ferina, la sustitución de las vacunas de células enteras por las vacunas acelulares, la mejora en la disponibilidad y sensibilidad de las pruebas diagnósticas y la aparición de cepas que escapan de la inmunidad producida por las vacunas acelulares. La tos ferina mantiene su presentación cíclica y Bordetella pertussis circula en todos los grupos de edad. En España desde el año 2010 la tos ferina se encuentra en epidemia sostenida que alcanzó el pico máximo en la onda 2014-2019. La tos ferina afecta a todas las edades, pero es típicamente una enfermedad infantil con las formas de presentación más graves en niños en los primeros meses de vida. En España la vacunación de tos ferina en las gestantes, que está implantada en todo el país desde 2016, está contribuyendo a la reducción de la enfermedad grave en los lactantes, particularmente en los tres primeros meses de vida, cuando todavía no se ha completado la pauta de primovacunación. Manteniendo altas coberturas con la administración sin demora de las dosis del calendario, (primovacunación a los 2, 4 meses, primer recuerdo a los 11 meses y segundo recuerdo a los 6 años) y promoviendo la vacunación de las gestantes, se reduce la intensidad de las epidemias y sobre todo el riesgo de enfermedad grave entre los más vulnerables. El objetivo general de este estudio es el análisis de los casos, hospitalizaciones y muertes por tos ferina en España en el periodo 2005-2020, evaluando el impacto de la vacunación de las embarazadas sobre la epidemiología de la enfermedad. Se analiza la calidad de la notificación de casos de tos ferina a la RENAVE. [EN] Whooping cough is considered a re-emerging disease in many areas of the world. In recent years, an increase in cases of whooping cough has been observed, both in Spain and in other countries with similar vaccination policies. The evanescence of the protection conferred by the pertussis vaccine and the replacement of whole cell vaccines by acellular vaccines could be contributing to the increase in cases worldwide. In addition, the improvement in the availability of simple and rapid diagnostic tests, such as PCR, facilitates the diagnosis and notification of pertussis cases. Pertussis maintains a cyclical presentation and B. pertussis circulates in all age groups. In Spain, pertussis has been in a sustained epidemic since 2010, peaking in the 2014-2019 wave. Pertussis affects all age groups, but is typically a childhood disease with the most severe forms of presentation in infants in the first months of life. In Spain, pertussis vaccination in pregnant women, implemented nationwide since 2016, is contributing to the reduction of severe disease in infants, particularly in the first three months of life, when the primary vaccination schedule has not yet been completed. Maintaining high coverage with prompt administration of schedule doses (primary vaccination at 2, 4, months, first booster at 11 months and second booster at 6 years) and promoting vaccination of pregnant women reduce the intensity of epidemics and especially the risk of severe disease among the most vulnerable. New pertussis vaccines providing more effective and longer-lasting protection against disease and reducing the circulation of B. pertussis in the population, are needed. The objective of this study is to analyse pertussis cases, hospitalisations and deaths in Spain in the period 2005-2020, assessing the impact of vaccination of pregnant women on the epidemiology of the disease. The quality of pertussis case reporting to the National Surveillance System (RENAVE) is analysed.Publication Comparison of circulation patterns of mumps virus in the Netherlands and Spain (2015-2020)(Frontiers Media, 2023-06) Gavilán, Ana M; van de Nes-Reijnen, Linda; Castellanos-Nadal, Ana Maria; Woudenberg, Tom; Lopez-Perea, Noemi; Masa-Calles, Josefa; Echevarria, Juan Emilio; Fernandez-Garcia, Aurora; Bodewes, Rogier; Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública); Instituto de Salud Carlos IIIBackground: Mumps is a viral infection mainly characterized by inflammation of the parotid glands. Despite of vaccination programs, infections among fully vaccinated populations were reported. The World Health Organization (WHO) recommends molecular surveillance of mumps based on sequencing of the small hydrophobic (SH) gene. The use of hypervariable non-coding regions (NCR) as additional molecular markers was proposed in multiple studies. Circulation of mumps virus (MuV) genotypes and variants in different European countries were described in the literature. From 2010 to 2020, mumps outbreaks caused by genotype G were described. However, this issue has not been analyzed from a wider geographical perspective. In the present study, sequence data from MuV detected in Spain and in The Netherlands during a period of 5 years (2015- March 2020) were analyzed to gain insights in the spatiotemporal spread of MuV at a larger geographical scale than in previous local studies. Methods: A total of 1,121 SH and 262 NCR between the Matrix and Fusion protein genes (MF-NCR) sequences from both countries were included in this study. Analysis of SH revealed 106 different haplotypes (set of identical sequences). Results: Of them, seven showing extensive circulation were considered variants. All seven were detected in both countries in coincident temporal periods. A single MF-NCR haplotype was detected in 156 sequences (59.3% of total), and was shared by five of the seven SH variants, as well as three minor MF-NCR haplotypes. All SH variants and MF-NCR haplotypes shared by both countries were detected first in Spain. Discussion: Our results suggest a transmission way from south to north Europe. The higher incidence rate of mumps in Spain in spite of similar immunization coverage in both countries, could be associated with higher risk of MuV exportation. In conclusion, the present study provided novel insights into the circulation of MuV variants and haplotypes beyond the borders of single countries. In fact, the use of MF-NCR molecular tool allowed to reveal MuV transmission flows between The Netherlands and Spain. Similar studies including other (European) countries are needed to provide a broader view of the data presented in this study.Publication La eliminación del sarampión y los programas de vacunación en Europa. Retos y perspectivas(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2019-06-06) Masa-Calles, JosefaLa eliminación del sarampión y los programas de vacunación en Europa. Retos y perspectivas. Una enfermedad potencialmente erradicable. Extensión de los programas de vacunación en el mundo. En los últimos 40 años: grandes avances en el control. El proceso de eliminación no avanza como se esperaba. Inmunización frente al Sarampión en los países de la UE/EEA. Fallos mantenidos del calendario originan muchos casos en niños y epidemias de sarampión. Los países establecen medidas para reducir las brechas en la inmunidad de la población. Unión Europea/EEA Vacunación obligatoria-recomendada y otras medidas a tomar.Publication Enfermedad neumocócica invasiva en España. Periodo 2015-2021(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2023) Soler Soneira, Marta; Sastre García, María; Amillategui Dos Santos, Rocío; Lopez-Perea, Noemi; Masa-Calles, Josefa; Cano-Portero, RosaIntroducción: La enfermedad neumocócica invasiva (ENI) es una enfermedad causada por la bacteria Streptococcus pneumoniae. El objetivo de este estudio fue analizar la información de la ENI en España durante el periodo 2015-2021. Método: Análisis epidemiológico descriptivo de los casos de ENI notificados a la Red Nacional de Vigilancia Epidemiológica. Las variables analizadas fueron: sexo, edad, fecha de inicio de síntomas, lugar de residencia, defunción y serotipo del agente patógeno. Resultados: Se notificaron 19.720 casos de ENI, el 58,8% fueron hombres. La tasa de incidencia (TI) durante el periodo fue creciente, estabilizándose en 2019 y disminuyendo en los años pandémicos (2020 y 2021). La tasa de incidencia acumulada del periodo (TIa) fue de 6,89 por 100.000 habitantes. Las mayores TI se observaron en menores de 5 años (especialmente en menores de 1 año (TIa de 21,4) seguida por el grupo de 65 y más años (TIa de 18,1). La mayor letalidad se presentó en el grupo de ≥65 años (letalidad de 21,63). Los serotipos 8 (20,5%) y 3 (14%) fueron los mayoritarios, constituyendo el 34,5% de los casos. Conclusiones: Las medidas de contención durante la pandemia tuvieron efecto en la reducción del número de casos de ENI. En 2021 las TI fueron similares a las de 2020 excepto en menores de 5 años (especialmente en menores de 1 año con una TI de 22,9). Debido a las diferencias existentes en la letalidad de los distintos serotipos es importante notificar las defunciones e investigar el serotipo que causó la enfermedad.Publication Epidemiología del Herpes Zóster en España(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2020-05-17) Masa-Calles, Josefa; Vila-Cordero, Beatriz; Lopez-Perea, Noemi; Carmona-Alferez, Rocio; Ojeda-Ruiz, Elena; Sastre García, María[ES] El Herpes Zóster (HZ) resulta de la reactivación de la infección latente por el virus de la varicela-zóster (VVZ) y es una patología frecuente que está asociada a estados de inmunosupresión y al envejecimiento. Se presenta el análisis de la información disponible en cuanto a incidencia y hospitalizaciones por Herpes Zóster y por su principal complicación, la Neuralgia Post-Herpética, en España entre 1998 y 2018. El HZ es una entidad de la edad adulta, las formas graves y las complicaciones del zóster ocurren más en las edades avanzadas de la vida. La eventual incorporación al calendario de la vacunación de HZ en los adultos necesitará de una monitorización estrecha del HZ en los próximos años. [EN] Herpes Zoster (HZ) is the reactivation of latent infection by the varicella-zoster virus (VVZ) and is a pathology associated with states of immunosuppression and aging. The analysis of the available information regarding incidence and hospitalizations for HZ and Post-herpetic Neuralgia in Spain between 1998 and 2018 is presented. HZ is a mainly adult entity. Complications like Post-herpetic Neuralgia occur more frequently in advanced ages of life. The eventual recommendation of vaccination against HZ in adults will require close monitoring of HZ in the coming years.Publication Epidemiología del sarampión, rubeola y síndrome de rubeola. Plan Nacional de Eliminación del Sarampión y de la Rubeola. Año 2015(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2017-10) Torres-de Mier, Maria de Viarce; Lopez-Perea, Noemi; Masa-Calles, JosefaObjetivos, estrategias y definiciones. Plan de eliminación y sistema de vigilancia en España. resultados de la vigilancia del sarampión, rubeola y SRC, España 2015.Publication Epidemiology of Herpes Zoster in the pre-vaccination era: establishing the baseline for vaccination programme's impact in Spain(European Centre for Disease Prevention and Control (ECDC), 2023-02) Risco Risco, Carlos; Herrador, Zaida; Lopez-Perea, Noemi; Martínez-Urbistondo, Diego; Suárez Del Villar Carrero, Rafael; Masa-Calles, JosefaBackground: Herpes zoster (HZ) affects 1 in 3 persons in their lifetime, and the risk of HZ increases with increasing age and the presence of immunocompromising conditions. In Spain, vaccination guidelines were recently updated to include the recommendation of the new recombinant zoster vaccine (RZV) for certain risk groups.AimTo describe the epidemiology of HZ-related hospitalisations in Spain in order to prioritise vaccination recommendations and define a baseline to monitor the effectiveness of vaccination policies. Methods: Retrospective study using the National Health System's Hospital Discharge Records Database, including all HZ-related hospitalisations from 1998 to 2018. Results: The 65,401 HZ-related hospitalisations, corresponded to an annual mean hospitalisation rate of 6.75 per 100,000 population. There was an increasing trend of HZ hospitalisations over the study period. This rate was higher in males and older age groups, particularly over 65 years. Comorbidities with higher risk of readmission were leukaemia/lymphoma (RR 2.4; 95% CI: 2.3-2.6) and solid malignant neoplasm (RR 2.2; 95% CI: 2.1-2.4). Comorbidities associated with higher risk of mortality were leukaemia/lymphoma (RR 2.9; 95% CI: 2.7-3.2), solid malignant neoplasm (RR 2.9; 95% CI: 2.7-3.1) and HIV infection (RR 2.2; 95% CI: 1.8-2.7). Conclusion: Of all patients hospitalised with HZ, those with greater risk of mortality or readmission belonged to the groups prioritised by the current vaccination recommendations of the Spanish Ministry of Health. Our study provided relevant information on clinical aspects of HZ and established the base for future assessments of vaccination policies.Publication Epidemiology of pertussis in two Ibero-American countries with different vaccination policies: lessons derived from different surveillance systems(BioMed Central (BMC), 2016-11-22) Solano, Rubén; Masa-Calles, Josefa; Garib, Zacarías; Grullón, Patricia; Santiago, Sandy L.; Brache, Altagracia; Domínguez, Ángela; Caylà, Joan A.; Instituto de Salud Carlos IIIBACKGROUND: Pertussis is a re-emerging disease worldwide despite its high vaccination coverage. European and Latin-American countries have used different surveillance and vaccination policies against pertussis. We compared the epidemiology of this disease in two Ibero-American countries with different vaccination and surveillance policies. METHODS: We compared the epidemiology of pertussis in Spain and the Dominican Republic (DR). We present a 10-year observational study of reported pertussis based on suspected and/or probable cases of pertussis identified by the national mandatory reporting system in both countries between 2005 and 2014. Both countries have a similar case definition for pertussis surveillance, although Spain applies laboratory testing, and uses real time PCR and/or culture for case confirmation while in DR only probable and/or suspected cases are reported. We analyzed incidence, hospitalization, case-fatality rates, mortality and vaccination coverage. RESULTS: The average annual incidence in children aged <1 year was 3.40/100,000 population in Spain and 12.15/100,000 in DR (p = 0.01). While the incidence in DR was generally higher than in Spain, in 2011 it was six times higher in Spain than in DR. The highest infant mortality in Spain was 0.017/100,000 in 2011, and the highest in DR was 0.08/100,000 in 2014 (p = 0.01). The proportion of hospitalized cases per year among children <1 year varied between 22.0% and 93.7% in Spain, and between 1.1% and 29.4% in DR (p = 0.0002), while mortality varied from 0 to 0.017 and 0 to 0.08 per 100,000 population in Spain and DR, respectively (p = 0.001). Vaccination coverage was 96.5% in Spain and 82.2% in DR (p = 0.001). CONCLUSIONS: Pertussis is a public health problem in both countries. Surveillance, prevention and control measures should be improved, especially in DR. Current vaccination programs are not sufficient for preventing continued pertussis transmission, even in Spain which has high vaccination coverage.Publication Genomic non-coding regions reveal hidden patterns of mumps virus circulation in Spain, 2005 to 2015(European Centre for Disease Prevention and Control (ECDC), 2018) Gavilán, Ana M; Fernandez-Garcia, Aurora; Rueda,, Angel; Castellanos-Nadal, Ana Maria; Masa-Calles, Josefa; Lopez-Perea, Noemi; Torres-de Mier, Maria de Viarce; De Ory, Fernando de; Echevarria, Juan Emilio; Instituto de Salud Carlos IIIBackgroundSince mumps vaccination was introduced in 1981 in Spain, the incidence of the disease has dropped significantly. However, cyclic epidemic waves and outbreaks still occur, despite high vaccination coverage. The World Health Organization (WHO) recommends genotyping to trace the pattern of mumps virus (MuV) circulation. Genotype H was predominant in Spain, but was replaced in 2005 by genotype G which has subsequently remained dominant. Of the small hydrophobic protein gene sequences, 78% are identical and belong to the MuVi/ Sheffield.GBR.1.05/[G]-variant. Aim: Our study aimed to investigate whether the circulation of MuV strains in Spain was continuous after the emergence of genotype G in 2005. Method: We obtained 46 samples from Spanish patients infected with MuVi/Sheffield.GBR.1.05/[G] during two epidemic waves and analysed them using new molecular markers based on genomic non-coding regions (NCRs) that discriminate subvariants of this virus strain. Results: Phylogenetic analyses of the nucleoprotein-phosphoprotein and matrix protein-fusion protein NCR indicated strain replacement after a drop in incidence in 2009, which had not been detectable by SH sequencing. Clustering of sequences from patients epidemiologically linked in the same outbreak suggests a potential use for these NCRs in outbreak characterisation. Conclusion: We suggest to consider their use in conjunction with the SH gene in the future WHO recommendations for MuV epidemiological surveillance.Publication Hybrid capture shotgun sequencing detected unexpected viruses in the cerebrospinal fluid of children with acute meningitis and encephalitis(Springer, 2024-03-04) Launes, Cristian; Camacho, Juan; Pons-Espinal, Marina; López-Labrador, F Xavier; Esteva, Cristina; Cabrerizo, Maria; Fernandez-Garcia, Maria Dolores; Fogeda, Marta; Masa-Calles, Josefa; Lopez-Perea, Noemi; Echevarria, Juan Emilio; Muñoz-Almagro, Carmen; Tarrago Asensio, David; Conferencia de Rectores de las Universidades Españolas; Consejo Superior de Investigaciones Científicas (España); Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública)Purpose: Investigation of undiagnosed cases of infectious neurological diseases, especially in the paediatric population, remains a challenge. This study aimed to enhance understanding of viruses in CSF from children with clinically diagnosed meningitis and/or encephalitis (M/ME) of unknown aetiology using shotgun sequencing enhanced by hybrid capture (HCSS). Methods: A single-centre prospective study was conducted at Sant Joan de Déu University Hospital, Barcelona, involving 40 M/ME episodes of unknown aetiology, recruited from May 2021 to July 2022. All participants had previously tested negative with the FilmArray Meningitis/Encephalitis Panel. HCSS was used to detect viral nucleic acid in the patients' CSF. Sequencing was performed on Illumina NovaSeq platform. Raw sequence data were analysed using CZ ID metagenomics and PikaVirus bioinformatics pipelines. Results: Forty episodes of M/ME of unknown aetiology in 39 children were analysed by HCSS. A significant viral detection in 30 CSF samples was obtained, including six parechovirus A, three enterovirus ACD, four polyomavirus 5, three HHV-7, two BKV, one HSV-1, one VZV, two CMV, one EBV, one influenza A virus, one rhinovirus, and 13 HERV-K113 detections. Of these, one sample with BKV, three with HHV-7, one with EBV, and all HERV-K113 were confirmed by specific PCR. The requirement for Intensive Care Unit admission was associated with HCSS detections. Conclusion: This study highlights HCSS as a powerful tool for the investigation of undiagnosed cases of M/ME. Data generated must be carefully analysed and reasonable precautions must be taken before establishing association of clinical features with unexpected or novel virus findings.Publication Increase of pertussis incidence in 2010 to 2012 after 12 years of low circulation in Spain(European Centre for Disease Prevention and Control (ECDC), 2014-08-14) Sizaire, Vinciane; Garrido-Estepa, Macarena; Masa-Calles, Josefa; Martinez de Aragon-Esquivias, Maria VictoriaIn Spain, whole cell pertussis vaccination started in 1975, with three doses before the age of 6-7 months. Doses at 15-18 months and 4-6 years were introduced in 1996 and 2001, respectively. Spain switched to an acellular vaccine in 2005. From 1998 to 2009, pertussis incidence rates remained ≤1.5 cases/100,000 inhabitants but increased from 2010 to 7.5 cases/100,000 in 2012. Data from 1998 to 2012 were analysed to assess disease trends and susceptible populations. We defined four epidemic periods: 1998-2001 (reference), 2002-05, 2006-09 and 2010-12. In 2002-05, the incidence rate increased in individuals aged 15-49 years (IRR: 1.41 (95% CI: 1.11-1.78)) and ≥50 years (IRR: 2.78 (95% CI: 1.78-4.33)) and in 2006-09 increased also in infants aged <3 months (IRR: 1.83 (95% CI: 1.60-2.09)). In 2010-12, the incidence rate increased notably in all age groups, with IRRs ranging between 2.5 (95% CI: 2.3-2.8) in 5-9 year-olds and 36.0 (95% CI: 19.4-66.8) in 20-29 year-olds. These results, consistent with the country's vaccination history, suggest a progressive accumulation of susceptible individuals due to waning immunity after years of low incidence. Further vaccination strategies should be assessed and implemented to prevent pertussis in pre-vaccinated infants, in whom the disease is more severe.Publication Informe anual 2019: Plan de Eliminación del Sarampión y la Rubeola en España(2021-02-09) Lopez-Perea, Noemi; Masa-Calles, Josefa; Fernandez-Garcia, Aurora; Perez-Olmeda, Mayte; Gallardo, Virtudes; Cebollada, Ana D; Huerta, Ismael; Magistris, Alicia; Grau, Paula; Rojo, Magdalena L; Viloria, Luis Javier; García, Marií Victoria; Gutiérrez, Gonzalo; Ruiz-Sopeña, Cristina; Torner, Núria; Izquierdo, Conchita; Huertas, Isabel; López-Tercero, María Mar; Losada, Isabel; Rodero, Inmaculada; García-Ortuzar, Visitación; García-Fulgueiras, Ana; Garcia-Cenoz, Manuel; González Carril, Fernando; Martínez Ochoa, Eva María; Blanco, Ángela; Rivas, Ana I; Castrillejo, Daniel; Navarro, JM; Pérez-Ruiz, Mercedes; Mosquera, Mar; Costa, Josep; Lopez-Perea, Noemi; Masa-Calles, Josefa; Fernandez-Garcia, Aurora; Perez-Olmeda, Mayte; Gallardo, Virtudes; Cebollada, Ana D; Huerta, Ismael; Magistris, Alicia; Grau, Paula; Rojo, Magdalena L; Viloria, Luis Javier; García, Marií Victoria; Gutiérrez, Gonzalo; Ruiz-Sopeña, Cristina; Torner, Núria; Izquierdo, Conchita; Huertas, Isabel; López-Tercero, María Mar; Losada, Isabel; Rodero, Inmaculada; García-Ortuzar, Visitación; García-Fulgueiras, Ana; Garcia-Cenoz, Manuel; González Carril, Fernando; Martínez Ochoa, Eva María; Blanco, Ángela; Rivas, Ana I; Castrillejo, Daniel; Navarro, JM; Pérez-Ruiz, Mercedes; Mosquera, Mar; Costa, Josep[ES] En España en 2019 el sarampión presentó el perfil de la fase post-eliminación: importado, casos en adultos y asociado a los entornos sanitarios. Se notificaron 287 casos de sarampión-incidencia 6,1 casos por millón de habitantes- ligeramente superior a la de años anteriores. La incidencia de rubeola fue extremadamente baja, solo tres casos confirmados incidencia de 0,06 casos por millón de habitantes. No se notificó ningún Síndrome de Rubeola Congénita. El sarampión ocurrió en personas no vacunadas –niños menores de un año y adultos mayores de 30 años. Se registraron casos en adultos que habían recibido dos dosis de vacuna, la última dosis una media de 10 años antes de contagiarse de sarampión. La falta de refuerzos naturales de la inmunidad por ausencia de circulación del virus en la población facilita la evanescencia de la inmunidad, particularmente evidente en las personas más expuestas, sobre todo trabajadores del ámbito sanitario. En 2019 el sarampión en España fue importado. Las importaciones llegaron de diferentes zonas del mundo, pero sobre todo de países europeos que estaban registrando brotes y epidemias sostenidas de sarampión. El sarampión tuvo escasa difusión en la población generando brotes de pequeño tamaño <10 casos; solo dos brotes registraron en torno a los 100 casos y en estos la transmisión en el entorno sanitario mantuvo la circulación del sarampión. Se notificaron tres casos de rubeola en personas no vacunadas que se contagiaron en el seno de un brote importado -notificado a finales de 2018– ocurrido entre personas adultas que no habían nacido en España. El sistema de vigilancia es adecuado para investigar los casos sospechosos de sarampión o rubeola una vez que se notifican; sin embargo para mantener los estándares de calidad que requiere el proceso de verificación de la eliminación tienen que mejorarse la sensibilidad en la identificación de sospechas clínicas y la oportunidad de su notificación a los servicios de vigilancia epidemiológica. El sarampión sigue siendo una amenaza trasfronteriza y solo una fuerte inmunidad de la población evitará la aparición de epidemias. La rubeola es rara y ocurre en personas susceptibles nacidas fuera de España. Las claves para mantener interrumpida la transmisión del sarampión y rubeola en España: son: mantener altas coberturas con dos dosis de vacunación infantil, promover la vacunación oportunista de adultos, viajeros y personas nacidas en otros países y zonas del mundo, asegurar la inmunidad de los profesionales del ámbito sanitario, establecer medidas de aislamiento que reduzcan la transmisión en los entornos asistenciales y mantener la calidad del sistema de vigilancia y de los laboratorios. La pandemia de COVID-19 y las medidas de control establecidas han reducido drásticamente la importación y la transmisión de sarampión en España con los últimos casos notificados en marzo 2020. Algunas incertidumbres asociadas a la situación epidémica: las restricciones en la asistencia sanitaria durante las primeras semanas de confinamiento podrían haber afectado las coberturas de vacunación, particularmente con la segunda dosis de vacuna triple vírica. La sobrecarga generada en el sistema de salud podría afectar a la vigilancia, notificación e investigación de las sospechas de sarampión o rubeola. [EN] In Spain in 2019 measles presented the profile of the post-elimination phase: imported, cases in adults and transmission associated with health environments. 287 confirmed cases of measles were reported along the year 2019, incidence of 6.1 cases per million population - slightly higher than in previous years. The incidence of rubella was extremely low, with only three confirmed cases; the incidence was 0.06 cases per million population. None Congenital Rubella Syndrome was reported. Measles occured in unvaccinated persons - children under one year and adults over 30 years of age. Cases were reported in adults who had received two doses of vaccine, the last dose on average 10 years before getting measles. The lasted lack of virus circulation in the population reduces the natural booster of immunity and consequently facilitates the evanescence of immunity, what is is particularly evident in those most exposed, especially among health care workers. In 2019 measles in Spain was imported. Importations came from different areas of the world, mostly from some European countries experiencing sustained measles outbreaks and epidemics. In general measles spread little in the population generating small size outbreaks <10 cases; In the two outbreaks that recorded about 100 cases, transmission was documented in health care facilities and among health care workers, which likely sustained transmission longer. The surveillance system is adequate to investigate suspected cases of measles or rubella once they are reported,; however, in order to maintain the quality standards required by the WHO-Europe elimination verification process, the sensitivity in the identification of clinical suspicions and the timeliness of their notification to epidemiological surveillance services must be improved. Measles remains a transboundary threat and only strong immunity of the population will prevent epidemics. Rubella is rare and occurs in susceptible persons born outside Spain. The keys to maintaining interrupted transmission of measles and rubella in Spain are: maintaining high coverage with two doses of childhood vaccination, promoting opportunistic vaccination of adults, travelers and people born in other countries, ensuring the immunity of healthcare professionals, establishing isolation measures that reduce transmission in healthcare settings and maintaining the quality of the surveillance system and laboratories. The pandemic of COVID-19 and the control measures established have drastically reduced the importation and transmission of measles in Spain with the last cases reported in March 2020. Some uncertainties associated with the epidemic situation are: restrictions on health care during the first weeks of lockdown could have affected vaccination coverage, particularly with the second dose of MMR vaccine. The overload generated in the health system could affect surveillance, notification and investigation of suspected measles or rubella.Publication Informe sobre la situación de la Tos ferina en España, 1998-2014(Instituto de Salud Carlos III (ISCIII). Centro Nacional de Epidemiología (CNE), 2015-06) Torres-de Mier, Maria de Viarce; Lopez-Perea, Noemi; Masa-Calles, Josefa[ES] En España, como en otros países con políticas de vacunación similares, la tosferina ha resurgido en los últimos años, se observa un progresivo aumento de la incidencia, hospitalización y mortalidad desde 2010. Entre las posibles causas que se señalan están: la mejora en el acceso a técnicas de diagnóstico rápido que permiten una mejor notificación de la enfermedad, la evanescencia del efecto protector de la vacuna y la menor efectividad de la vacuna acelular comparada con la efectividad de la vacuna de células enteras. La menor efectividad de la vacuna acelular comparada con la efectividad de la vacuna de células enteras. La tos ferina está aumentando en todos los grupos de edad pero lo preocupante, por su gravedad, es la enfermedad en los lactantes. Actualmente la Ponencia de Programas y Registro de Vacunaciones está revisando el problema nacional de vacunación frente a la tos ferina, con el objetivo de mejorar el control de la enfermedad en los lactantes; se está valorando incluir la recomendación de vacunar frente a tos ferina a las embarazadas en el tercer trimestre de gestación para reducir la incidencia de tos ferina en los menores de tres meses. Necesitamos mejorar la vigilancia de la tos ferina en la RENAVE, sobre todo en los menores de un año. Si se aplica el protocolo de vigilancia en tos ferina 2013 y se notifican todas las variables aprobadas, se pueden monitorizar de manera oportuna el impacto de las medidas que se recomienden. Se podría conocer oportunamente la incidencia general e incidencia por grupo de edad, la gravedad y la mortalidad de la tos ferina. [EN] Pertussis Epidemiological Report, Spain 1998-2014 Summary In recent years, Spain and other countries with similar vaccination policies have seen a reappearance of pertussis cases. Since 2010, incidence, hospitalization and mortality rates have experienced a progressive increase. Rapid tests have allowed for early diagnosis and contributed to a rise in cases detected. Figures show an upwards trend (mainly) due to vaccine effects waning over time and poorer effectiveness of acellular vaccines when compared to whole-cell pertussis vaccines. Pertussis cases are rising across all age groups. Those among infants under six months old are especially worrisome. The Ponencia de Programas y Registro de Vacunaciones -Report on Vaccination Programs and Registration- is currently reviewing the national program of pertussis vaccination. Implementation of one additional dTpa dose on pregnant women is under discussion in order to better manage the disease among infants. Pertussis surveillance must be stepped up, particularly among infants under 1 year old. Outcome of any recommendation can only be assessed if the 2013 RENAVE Surveillance Protocol is followed and all mandatory variables are reported. Overall incidence, age distribution, hospitalization and mortality rates could then be monitored in an accurate and timely manner.Publication Investigating Local Patterns of Mumps Virus Circulation, Using a Combination of Molecular Tools(Multidisciplinary Digital Publishing Institute (MDPI), 2023-12-13) Gavilán, Ana M; Perán-Ramos, Paula; Sanz, Juan Carlos; García-Comas, Luis; Pérez-Abeledo, Marta; Castellanos-Nadal, Ana Maria; Berciano, Jose Miguel; Lopez-Perea, Noemi; Masa-Calles, Josefa; Echevarria, Juan Emilio; Fernandez-Garcia, Aurora; Centro de Investigación Biomédica en Red - CIBERESP (Epidemiología y Salud Pública); Instituto de Salud Carlos IIIMumps is a vaccine-preventable disease caused by the mumps virus (MuV). However, MuV has re-emerged in many countries with high vaccine coverage. The World Health Organization (WHO) recommends molecular surveillance based on sequencing of the small hydrophobic (SH) gene. Additionally, the combined use of SH and non-coding regions (NCR) has been described in different studies, proving to be a useful complement marker to discriminate general patterns of circulation at national and international levels. The aim of this work is to test local-level usefulness of the combination of SH and MF-NCR sequencing in tracing hidden transmission clusters and chains during the last epidemic wave (2015-2020) in Spain. A database with 903 cases from the Autonomous Community of Madrid was generated by the integration of microbiological and epidemiological data. Of these, 453 representative cases were genotyped. Eight different SH variants and thirty-four SH haplotypes were detected. Local MuV circulation showed the same temporal pattern previously described at a national level. Only two of the thirteen previously identified outbreaks were caused by more than one variant/haplotype. Geographical representation of SH variants allowed the identification of several previously undetected clusters, which were analysed phylogenetically by the combination of SH and MF-NCR, in a total of 90 cases. MF-NCR was not able to improve the discrimination of geographical clusters based on SH sequencing, showing limited resolution for outbreak investigations.Publication Last cases of rubella and congenital rubella syndrome in Spain, 1997-2016: The success of a vaccination program(Elsevier, 2019) Seppälä, Elina Marjukka; Lopez-Perea, Noemi; Torres-de Mier, Maria de Viarce; Echevarria, Juan Emilio; Fernandez-Garcia, Aurora; Masa-Calles, Josefa; Instituto de Salud Carlos IIIWith a highly immunized population, rubella infection in Spain is so low that the WHO has declared the elimination of rubella. Rubella in pregnant women is also very rare. The objective of this study is to describe the last cases of congenital rubella syndrome reported and recommend actions to maintain the status of the disease as eliminated. The CRS cases reported to the Spanish National Epidemiological Surveillance Network between 1997 and 2016 were studied, and the epidemiological, clinical, diagnostic and maternal characteristics of newborns with CRS described. The incidence of CRS was calculated using Birth Statistics from the Spanish National Statistics Agency (INE). Twenty-three cases of CRS were reported, 70% of which were associated with rubella outbreaks. The most common clinical conditions were heart disease (52.2%), deafness (39.1%) and cataracts (30.4%); 91.3% of cases were confirmed by laboratory testing. 70.0% were born from a non-vaccinated foreign mother, resident in Spain (cumulative rate incidence (CR): 1.1/100,000 births), with mothers coming from Africa (36.0%), Latin America (29.0%), Eastern Europe (21.0%) and Asia (14.0%). Six were born to Spanish mothers (CR: 0.08/ 100,000 births), the last of which were in 2005. The majority of CRS cases were born to unvaccinated immigrant women infected in Spain during rubella outbreaks. Universal vaccination in childhood is the most efficient strategy to prevent rubella. The limited circulation of the virus will, however, quickly lead to a loss of awareness about rubella among clinicians and epidemiologists. It is necessary to maintain protocols capable of identifying signs consistent with rubella in pregnant women and signs suggestive of congenital rubella in newborns.Publication Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014-2020(Multidisciplinary Digital Publishing Institute (MDPI), 2021-10-02) Lopez-Perea, Noemi; Fernandez-Garcia, Aurora; Echevarria, Juan Emilio; De Ory, Fernando de; Perez-Olmeda, Mayte; Masa-Calles, Josefa; Instituto de Salud Carlos IIIThe MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.Publication Measles virus genotype D4 strains with non-standard length M-F non-coding region circulated during the major outbreaks of 2011-2012 in Spain(Public Library of Science (PLOS), 2018) Gil, Horacio; Fernandez-Garcia, Aurora; Mosquera Gutierrez, Maria del Mar; Hübschen, Judith M; Castellanos-Nadal, Ana Maria; De Ory, Fernando de; Masa-Calles, Josefa; Echevarria, Juan Emilio; Instituto de Salud Carlos IIIIn recent decades, vaccination has substantially reduced the number of measles cases to levels close to the elimination stage. However, major measles outbreaks occurred in Europe during 2010-2012, after the introduction of the D4-Enfield lineage. We have performed a molecular characterization of 75 measles virus genotype D4 strains from patients infected in Spain between 2004 and 2012 by sequencing the N-450 region and the M-F non-coding region (M-F NCR) in order to identify genetic features of these viruses. The analysis of the N-450 region confirmed that all samples obtained since 2008 belonged to variants or sets of identical sequences of the D4-Enfield lineage, including a new one named MVs/Madrid.ESP/46.10/. Analysis of the M-F NCR showed insertions and deletions associated with previously described, uncommon non-standard genome length measles viruses. This genetic feature was identified in the D4-Enfield lineage viruses, but not in the other D4 viruses that were circulating in Spain before 2008, suggesting that these non-standard length M-F NCR sequences are characteristic of the D4-Enfield lineage. The results of the phylogenetic analysis of Spanish M-F NCRs suggest higher resolution in discriminating strains than did the N-450 analysis. In addition, the results of the analysis of the M-F NCR on the MVs/Madrid.ESP/46.10/ sub-lineage seem to support the potential utility of this region as a tool for epidemiological surveillance complementary to the N-450 region, as previously suggested. Further investigation on this question, as well as the surveillance of new potentially emerging strains with non-standard length M-F NCR are strongly recommended as part of future strategies for measles elimination.
- «
- 1 (current)
- 2
- 3
- »