Anna Vilella

A statistical model for hospital admissions caused by seasonal diseases

We present a model based on two-order integer-valued autoregressive time series to analyze the number of hospital emergency service arrivals caused by diseases that present seasonal behavior. We also introduce a method to describe this seasonality, on the basis of Poisson innovations with monthly means. We show parameter estimation by maximum likelihood and model validation and show several methods for forecasting, on the basis of long-time means and short-time and long-time prediction regions. We analyze an application to model the number of hospital admissions per week caused by influenza.

Viscerotropic disease: Case definition and guidelines for collection, analysis, and presentation of immunization safety data

iscerotropic disease: Case definition and guidelines for collection, analysis, and resentation of immunization safety data ark D. Gershmana,∗, J. Erin Staplesb, Adwoa D. Bentsi-Enchill c, J. Gabrielle Breugelmansd, lacus S. Britoe, Luiz Antonio Bastos Camachof, Pascale Cotting, Cristina Domingoh, Anna Durbin i, oaquim Gasconj, Fouzia Guenanechek,1, Edward B. Hayes j, Zsuzsanna Jelenik l, Alena Khromavam, einaldo de Menezes Martinsn, Mario Masana Wilsono,2, Nathalie Massyp, Abdulsalami Nasidiq, atthias Niedrigh, Adam Sherwatr,3, Theodore Tsai s, Anna Vilella j, Mary Elizabeth Wilsont, atrin S. Kohla , The Brighton Collaboration Viscerotropic Disease Working Group

Influenza A H1N1 in HIV-infected adults.

HIV‐infected adults are considered to be at higher risk for influenza A H1N1 complications but data supporting this belief are lacking. We aimed to compare epidemiological data, clinical characteristics, and outcomes of influenza A H1N1 infection between HIV‐infected and ‐uninfected adults.

Influence of a Vaccination Schedule on Viral Load Rebound and Immune Responses in Successfully Treated HIV-Infected Patients

Vaccination is recommended for HIV-infected patients. Transient increases of viral load (VL) and risk of developing resistance to HAART have been described. In addition, VL rebounds could increase HIV-specific immune responses. Twenty-six successfully treated HIV-infected adults were randomized to receive a vaccination schedule or placebo during 12 months. Afterward, HAART was discontinued. Influences of vaccination over VL, genotypic mutations, different T cell subsets, and HIV-1-specific immune responses were evaluated. Patients did not present any secondary effect. No differences in incidence of detectable VL determinations were detected between groups [relative risk 0.54 (95% CI 0.23-1.26)]. No relevant resistance mutations were detected. The vaccinated group showed a significant drop in CD4(+) T cells (p = 0.046) associated with increases in activated T cells. HIV-1-specific lymphoproliferative responses increased more in the vaccinated group during the vaccination period. Viral rebound dynamics after interrupting HAART were similar in both groups. A vaccination schedule in successfully treated HIV patients was safe, was not associated with an increase in detectable VL, and did not increase the risk of developing resistance mutations. However, it induced an increase in T cell activation and a drop in CD4(+) T cells, although these changes did not influence the VL rebound dynamics after HAART interruption.

Yellow fever-associated viscerotropic disease in Barcelona, Spain.

Yellow fever vaccine is a live, attenuated viral preparation from the 17D virus strain. Since 1996, 34 cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) have been described. We report a new case of YEL-AVD. Given the potential risks associated with the vaccine, physicians should consider vaccination only for patients truly at risk for exposure to yellow fever, especially for primovaccination.

Incidence of respiratory viruses among travelers with a febrile syndrome returning from tropical and subtropical areas.

Fifty million people are estimated to travel from industrial countries to the tropics annually. In spite of exhaustive studies and widely different diagnosis among returned patients, some cases of febrile illnesses remain without an etiological diagnosis, suggesting that these cases could be due to viral respiratory tract infections. From August 2005 to October 2006, 118 febrile patients without a specific diagnosis in their first visit at the Center for International Health of the Hospital Clínic of Barcelona were included. In all of them, in order to study respiratory viruses, a nasopharyngeal swab was collected. Clinical and radiological features and epidemiological data, as well as other samples for microbiologic studies, were also collected during consultation. Based on the physicians judgment at the time of consultation, patients were classified into four groups: respiratory symptoms (62%), febrile syndrome with nonspecific symptoms (24%), digestive symptoms (10%), and patients presenting both respiratory and digestive symptoms (4%). A pathogen microorganism was detected in 61 patients (52%). Respiratory viruses were detected in 44 out of 118 (37%) travelers included in the study, representing 56% of the patients with respiratory symptoms. The most frequently viruses detected were influenza virus (38%), rhinovirus (23%), adenovirus (9%), and respiratory syncytial virus (9%). Respiratory viruses have been shown to play an important role in imported fever. In light of the fact that international tourism is an increasing phenomenon, new strategies to prevent the spread of respiratory viruses should be considered, specially for influenza when a vaccine is available. J. Med. Virol. 80:711–715, 2008.

Measles in Travelers: Are We Aware Enough?

Measles is still an important public health concern in most developing countries. Nonimmune or single-dose vaccinees traveling to high-endemic countries should be advised on the risk of acquiring the infection. We describe two cases of imported measles in Spanish travelers.

Economic Impact of a New Rapid PCR Assay for Detecting Influenza Virus in an Emergency Department and Hospitalized Patients

Seasonal influenza causes significant morbidity and mortality and has a substantial economic impact on the healthcare system. The main objective of this study was to compare the cost per patient for a rapid commercial PCR assay (Xpert® Flu) with an in-house real-time PCR test for detecting influenza virus. Community patients with influenza like-illness attending the Emergency Department (ED) as well as hospitalized patients in the Hospital Clínic of Barcelona were included. Costs were evaluated from the perspective of the hospital considering the use of resources directly related to influenza testing and treatment. For the purpose of this study, 366 and 691 patients were tested in 2013 and 2014, respectively. The Xpert® Flu test reduced the mean waiting time for patients in the ED by 9.1 hours and decreased the mean isolation time of hospitalized patients by 23.7 hours. This was associated with a 103€ (or about

Persistence of yellow fever vaccine RNA in urine.

113) reduction in the cost per patient tested in the ED and 64€ (

Vaccination strategies against hepatitis A in travelers older than 40 years: an economic evaluation.

70) per hospitalized patient. Sensitivity analyses showed that Xpert® Flu is likely to be cost-saving in hospitals with different contexts and prices.