Alejandro Álvaro-Meca

The burden of hospitalisations for community-acquired pneumonia (CAP) and pneumococcal pneumonia in adults in Spain (2003–2007)

All hospital discharges and deaths related to CAP and pneumococcal-pneumonia from adults over 50 from 2003 to 2007 in Spain were obtained. Among the 447,670 Pneumonia-all causes discharges 17% were pneumococcal pneumonia. The annual hospitalisation rate was 6.27 and 1.09 cases per 1000, respectively. 75,932 deaths for Pneumonia-all causes and 9062 for pneumococcal-pneumonia were reported. CAP and pneumococcal pneumonia are major causes of morbidity and mortality in Spain, especially in the elderly. Despite current preventive measures, no significant changes in hospitalisation, mortality and case-fatality rates were found over the study period. Future preventive measures, like vaccination, could overcome these limitations.

Hospitalizations associated with rotavirus gastroenteritis in Spain, 2001–2005

BackgroundThis study aims to describe and analyze hospital admissions in Spain due to rotavirus infections among children aged 5 years or under during the period 2001–2005, along with the associated health cost.MethodsTo update estimates of rotavirus hospitalizations rates in Spain, we conducted a retrospective study of 5 years of national hospitalization data associated with acute gastroenteritis using the Minimum Basic Data Set.ResultsDuring the study period, a total of 17.1% of all admissions due to acute gastroenteritis of any etiology in children aged ≤ 5 years were attributable to rotavirus infection as determined by the rotavirus-specific International Classification of Diseases, ninth revision, Clinical Modification code. A mean incidence of 135 hospital admissions attributable to rotavirus per 100,000 children aged ≤ 5 years was found. Hospitalizations associated with rotavirus had a marked winter-time seasonality. The estimated cost of hospital admission attributable to rotavirus has risen from 3 million euros estimated for 2001 to almost 7 million euros estimated in 2005.ConclusionRotavirus gastroenteritis remains an important cause of hospitalizations in Spanish children, mostly during the winter season.

Epidemiology of suicide in Spain, 1981–2008: A spatiotemporal analysis

OBJECTIVE To analyse the epidemiology of suicide, and compare its occurrence between the sexes and in various regions in Spain. METHOD Age-specific analysis and spatiotemporal analysis to analyse death by suicide between 1981 and 2008 in Spain. STUDY DESIGN Ecological study. RESULTS Death by suicide has decreased since the 1990s in Spain, although peaks in suicides correspond with times of economic crisis. Death by suicide was more common among men than among women, although the suicide mortality rate increased over the study period among women aged 35-49 years. Geographical analysis showed that rural populations and areas with historically higher levels of unemployment have higher suicide rates. In contrast, less-populated regions have lower suicide rates. CONCLUSION Suicides in Spain exhibit a clear geographic pattern and occur at different rates between the genders. The results suggest an increasing number of suicides among women aged 35-49 years over the study period.

The burden of hospitalizations for meningococcal infection in Spain (1997–2008)

All hospital discharges and deaths related to invasive meningococcal disease, meningococcal meningitis and meningococcemia in the general population from 1997 to 2008 in Spain were obtained. Among the 11,611 meningococcal infection related discharges 53% were meningococcal meningitis and 55% were meningococcemia. The annual hospitalization rate was 2.33, 1.23 and 1.29 cases per 100,000 for invasive meningococcal disease, meningococcal meningitis and meningococcemia, respectively. 846 deaths for invasive meningococcal disease, 235 for meningococcal meningitis and 605 for meningococcemia were reported. Although an important decrease in meningococcal infections related morbidity and mortality has occurred in the last twelve years in Spain, they still continue being major causes of hospitalization and death, especially in the children up to 2 years of age. Future preventive measures, such as vaccination with vaccines covering new conjugated serogroups (B and ACYW135), could further improve population health.

Epidemiologic trends of cancer diagnoses among HIV-infected children in Spain from 1997 to 2008.

Background: The introduction of highly active antiretroviral therapy (HAART) has influenced the incidence of cancer in people with human immunodeficiency virus (HIV) infection. The aim of this study was to evaluate changes in the pattern of cancer rates in HIV-infected children on HAART during over a decade of follow-up. Patients and Methods: We carried out a case-control study. Data were obtained from the records of the minimum basic data set of hospitals in Spain from 1999 to 2008. The epidemiologic trends of cancer diagnoses were evaluated through 3 calendar periods: early-period HAART: 1997–1999, midperiod HAART: 2000–2002, and late-period HAART: 2003–2008). Results: HIV-infected children had higher rates of cancer diagnosis than HIV-negative children (P < 0.001) for both acquired immunodeficiency disease syndrome (AIDS)-defining malignancies (ADM) and non-AIDS-defining malignancies (non-ADM). The highest rates of cancer diagnosis in HIV-positive children were for non-Hodgkin lymphoma, malignant neoplasm of bone and articular cartilage, and Hodgkin lymphoma. When we compared the 3 calendar periods, we found that the rate of ADM diagnoses decreased (from 9.1 to 3.6 to 1.0 cancers per 1000 HIV-children/yr; P < 0.05) and that the rate of non-ADM diagnoses increased (from 0.6 to 5.0 to 8.7 cancers per 1000 HIV-children/yr; P < 0.05). Moreover, the overall rate of cancer diagnoses (ADM plus non-ADM) did not change during the study period (9.7, 8.7, and 9.7 cancers per 1000 HIV-children/yr). Conclusions: HIV-infected children had a dramatic decrease in the rate of ADM diagnoses and an increase in the rate of non-ADM diagnoses. The overall cancer diagnosis rate has not decreased during the past decade and the incidence of cancer still remains high in HIV-infected children in Spain.

Time Trends in Ischemic Stroke among Type 2 Diabetic and Non-Diabetic Patients: Analysis of the Spanish National Hospital Discharge Data (2003-2012)

Background Type 2 Diabetes (T2DM) is the most rapidly increasing risk factor for ischemic stroke. We aimed to compare trends in outcomes for ischemic stroke in people with or without diabetes in Spain between 2003 and 2012. Methods We selected all patients hospitalized for ischemic stroke using national hospital discharge data. We evaluated annual incident rates stratified by T2DM status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, and in-hospital outcomes. We calculated in-hospital mortality (IHM), length of hospital stay (LOHS) and readmission rate in one month after discharge. Time trend on the incidence of hospitalization was estimated fitting Poisson regression models by sex and diabetes variables. In-hospital mortality was analyzed using logistic regression models separate for men and women. LOHS were compared with ANOVA or Kruskal-Wallis when necessary. Results We identified a total of 423,475 discharges of patients (221,418 men and 202,057 women) admitted with ischemic stroke as primary diagnosis. Patients with T2DM accounted for 30.9% of total. The estimated incidence rates of discharges increased significantly in all groups. The incidence of hospitalization due to stroke (with ICD9 codes for stroke as main diagnosis at discharge) was higher among those with than those without diabetes in all the years studied. T2DM was positively associated with ischemic stroke with an adjusted incidence rate ratio (IRR) of 2.27 (95% CI 2.24–2.29) for men and 2.15 (95%CI 2.13–2.17) for women. Over the 10 year period LOHS decreased significantly in men and women with and without diabetes. Readmission rate remained stable in diabetic and non diabetic men (around 5%) while slightly increased in women with and without diabetes. We observed a significant increase in the use of fibrinolysis from 2002–2013. IHM was positively associated with older age in all groups, with Charlson Comorbidity Index > 3 and atrial fibrillation as risk factors. The IHM did not change significantly over time among T2DM men and women ranging from 9.25% to 10.56% and from 13.21% to 14.86%, respectively; neither did among non-diabetic women. However, in men without T2DM IHM decreased significantly over time. Diabetes was associated to higher IHM only in women (OR 1.07; 95% CI, 1.05–1.11). Conclusions Our national data show that incidence rate of ischemic stroke hospitalization increased significantly during the period of study (2003–2012). People with T2DM have more than double the risk of ischemic stroke after adjusting for other risk factors. Women with T2DM had poorer outcomes- IHM and readmission rates- than diabetic men. Diabetes was an independent factor for IHM only in women.

Impact of non-routine rotavirus vaccination on hospitalizations for diarrhoea and rotavirus infections in Spain

This study shows hospital discharges related to all-cause diarrhoea and rotavirus infection in children up to five years of age from 2005 to 2009 in Spain. Rotavirus vaccines have been available in Spain since late 2006 and early 2007. They are neither funded nor reimbursed by the National Health Care System. However, they are recommended by the Spanish Association of Pediatricians and prescribed by paediatricians. The vaccination coverage was 17% in 2007, 35% in 2008 and 38% in 2009. Among a total of 111,738 hospitalizations recorded, 24% (N=26,500) were coded as rotavirus and 14% (N=16,217) as diarrhoea of undetermined aetiology. The overall annual incidence of hospitalization was 991,235 and 144 per 100,000 children up to five years of age for all-causes diarrhoea, rotavirus infection and diarrhoea of undetermined aetiology respectively. The annual rate significantly decreased during the study period. Hospitalization rates for all-cause diarrhoea, rotavirus infection and diarrhoea of undetermined aetiology in children under five years of age in 2009 were 35, 37 and 36% lower than in the period 2005-2006, before rotavirus vaccine introduction. This decrease was greater in children <12 months of age: 42% for all-cause diarrhoea and 43% for rotavirus and diarrhoea of undetermined aetiology. The use of rotavirus vaccines, with relatively low vaccination coverage, in Spain has been shown to decrease hospitalizations for rotavirus gastroenteritis and all-cause diarrhoea during the study period.

Low immunologic response to highly active antiretroviral therapy in naive vertically human immunodeficiency virus type 1-infected children with severe immunodeficiency.

We conducted a retrospective study to analyze the CD4+ recovery of naive vertically human immunodeficiency virus-infected children with severe immunodeficiency who were followed up during at least 4 years of receiving highly active antiretroviral therapy (HAART). Children with baseline CD4+ of <15% did not reach a mean CD4+ of ≥25% after the 4th year on HAART. We conclude that starting HAART after severe immunosuppression of naive HIV-infected children may not be effective for recovery of normal %CD4+.

Reduction in mycobacterial disease among HIV-infected children in the highly active antiretroviral therapy era (1997-2008).

Background: HIV-infected children are at increased risk of developing mycobacterial disease. The aim of this study was to estimate the change in mycobacterial disease rate in HIV-infected children and adolescents in the highly active antiretroviral therapy (HAART) era. Methods: We carried out a retrospective study. Data were obtained from the records of the minimum basic data set of hospitals in Spain from 1997 to 2008. The epidemiologic trends of mycobacterial diseases were evaluated through the following 3 calendar periods: early-period HAART (1997–1999), midperiod HAART (2000–2002), and late-period HAART (2003–2008). Results: We analyzed 1307 HIV-infected children and 5228 HIV-uninfected children. HIV-infected children had similar rate of tuberculosis (TB) and nontuberculous mycobacteria (NTM) disease, and they had an overall rate of mycobacterial disease higher than that of HIV-uninfected children (P < 0.001). In HIV-infected children, the highest rates were for pulmonary TB (15/42 [35.7%]) in the TB category and disseminated mycobacterium (9/42 [21.4%]) in the NTM category. The overall rate of mycobacterial disease (events per 1000 HIV-infected children-year) decreased from 1997–1999 to 2003–2008 (5.88–1.63, P = 0.007) and from 2000–2002 to 2003–2008 (4.20–1.63, P = 0.021). Furthermore, the rate of TB decreased from 1997–1999 to 2000–2002 (3.53–0.84, P = 0.016) and from 1997–1999 to 2003–2008 (3.53–1.31, P = 0.030), and the rate of NTM disease decreased from 2000–2002 to 2003–2008 (3.36–0.32, P = 0.002). Conclusions: The rate of mycobacterial disease decreased among HIV-infected children in the HAART era, but the incidence of mycobacterial disease still remains higher than in the general population.

NS3 Resistance-Associated Variants (RAVs) in Patients Infected with HCV Genotype 1a in Spain.

Background Resistance-associated variants have been related to treatment failure of hepatitis C virus (HCV) therapy with direct-acting antiviral drugs. The aim of our study was to analyze the prevalence of clinically relevant resistance-associated variants within NS3 in patients infected with HCV genotype 1a (GT1a) in Spain. Methods We performed a cross-sectional study on 2568 patients from 115 hospitals throughout Spain (2014–2015). The viral NS3 protease gene was amplified by nested polymerase chain reaction and sequenced by Sanger sequencing using an ABI PRISM 377 DNA sequencer. Additionally, clade information for genotype 1a was obtained by using the software geno2pheno (http://hcv.geno2pheno.org/). Results In total, 875 out of 2568 samples were from human immunodeficiency virus (HIV)/HCV-coinfected patients. Q80K was the main RAV found in our patients (11.1%) and the rest of the resistance-associated variants had a lower frequency, including S122G (6.23%), T54S (3.47%), V55A (2.61%), and V55I (2.15%), which were among the most frequent after Q80K. Overall, 286 samples had the Q80K polymorphism (11.1%) and 614 (23.9%) were GT1a clade I. HIV/HCV-coinfected patients had a higher frequency of Q80K and GT1a clade I than HCV-monoinfected patients (12.9% vs. 9.6% [p = 0.012] and 28.5% vs. 21.4% [p<0.001], respectively). Both the prevalence of Q80K and GT1a clade I were not uniform throughout the country (p<0.001), which ranged from 7.3%-22.2% and 15.7%-42.5%, respectively. The frequency of the Q80K polymorphism was far higher in patients infected with GT1a clade I than in patients infected with GT1a clade II (41.5% vs. 1.6%; p<0.001). Conclusions The prevalence of most resistance-associated variants in NS3 was low in patients infected with HCV GT1a in Spain, except for Q80K (11.1%), which was also notably higher in HIV/HCV-coinfected patients. The vast majority of Q80K polymorphisms were detected in GT1a clade I.