Dionisio Herrera

Enteritis por Salmonella en Huesca. 1996-1999

Fundamento La enteritis por Salmonella continua siendo una importante causa de gastroenteritis infecciosa, y se estima que es responsable del 85% de los brotes de origen alimentario en Espana. Constituye, sin duda, un problema de salud publica en el que se encuentran implicados diversos servicios asistenciales y preventivos. Pacientes y metodo Utilizando dos fuentes de informacion, el sistema de Enfermedades de Declaracion Obligatoria (EDO) y los Laboratorios Microbiologicos Hospitalarios (LMH), se obtiene una estimacion de la incidencia de salmonelosis mediante la aplicacion del metodo de captura-recaptura. Asi mismo, se realiza un estudio descriptivo de la misma y se identifican los serogrupos mas frecuentes de Salmonella en la provincia de Huesca en el periodo 1996-1999. Resultados Se obtiene un total de 959 casos, lo que representa una tasa media anual de 116,6 por 105 habitantes. El numero de casos estimados es de 1.145 (tasa media anual de 139,5 × 10–5). La tasa de exhaustividad es mayor para LMH (68%; IC del 95%, 66-71). El grupo D es el mas frecuente (53,4%) y dentro de el, Salmonella enteritidis. En el 31% de los casos se presenta en menores de 5 anos y en el 38,2% del total de casos hay un ingreso hospitalario. Los casos presentan una clara estacionalidad en los meses de mayo a septiembre, con unpico en el mes de agosto. Conclusiones La mejora de la notificacion e identificacion de casos a partir de las fuentes declarantes y de los servicios de laboratorio permite establecer un mejor conocimiento de la enfermedad. Las cifras obtenidas y su clasificacion por grupo-serotipo son similares respecto a otros estudios.

Evaluación del control de la tuberculosis en un área de la Comunidad de Madrid, España (1999–2004)

OBJECTIVE Area 7 of the autonomous region of Madrid has one of the highest incidences of tuberculosis (23/100,000 population per year 2004). This study aimed to identify tuberculosis control in this area. METHODS A descriptive study of tuberculosis cases diagnosed in area 7 from January 1, 1999 to December 31, 2004 was carried out by analyzing the incidence of tuberculosis and the management of cases and their contacts. We also analyzed the microepidemics that occurred during this period. RESULTS The incidence of tuberculosis in area 7 during this period was 30.9/100,000 inhabitants. Respiratory tuberculosis accounted for 80.9% of all tuberculosis cases; of these, contact investigation was only undertaken in 38%. Thirty-five percent of cases were lost to follow-up. In the 24 microepidemics detected during the study period, 29 secondary cases were diagnosed; of these, the protocol for contact investigation was not correctly followed in 48%. CONCLUSION The lack of information and/or errors in the management of cases and their contacts should be corrected by establishing a new program to ensure proper treatment and follow-up of cases, contact investigations and correct reporting.

Investigación de una toxiinfección alimentaria en un centro penitenciario de alta ocupación

Background: On September 25 2005, more than 100 inmates (almost 5% of the 1,800 prison population) experienced sudden onset gastroenteritis. This outbreak was the largest foodborne outbreak described in a prison population in Spain. Our objective was to confirm the outbreak, identify risk factors, implement control measures, and provide recommendations. Methods: We conducted a cohort analysis of a stratified random sample of all the inmates, a cohort analysis of the one of the prison blocks, and an environmental investigation. Results: A total of 221 inmates were selected, of which 196 were interviewed. Twenty-eight percent had gastroenteritis and the main symptoms were abdominal pain (85%) and diarrhea (71%). All foods consumed caused similar attack rates. Factors associated with the risk of illness were eating the entire portion of seafood cocktail at lunch or all of the fried shrimp at dinner on September 24 (RR = 2; 95% CI, 1.1-3.8, and RR = 1.8; 95% CI, 1.1-3.1). Analysis of one of the prison blocks yielded results similar to those of the random sample. Clostridium perfringens, Bacillus cereus and Escherichia coli were isolated from a sample of the seafood cocktail. Conclusion: A gastroenteritis outbreak caused by several pathogens was confirmed. Both the reported symptoms and the calculated incubation periods corresponded to the pathogens isolated. Preparation of food in prison facilities should meet minimum safety standards, including refrigeration and training of food handlers.

Estudio comparado de infección por Salmonella y Campylobacter en Huesca. 1996-1999

Fundamentos: Los generos Salmonella y Campylobacter son los principales agentes bacterianos causantes de enteritis en el hombre en los paises desarrollados. El objetivo del presente trabajo es estudiar las caracteristicas descriptivas de los casos de infeccion por Salmonella y por Campylobacter y describir su tendencia y variacion estacional en la provincia de Huesca para el periodo 1996-1999 Metodo: Las fuentes de informacion han sido los Laboratorios Microbiologicos Hospitalarios (LMH) que realizan analiticas de coprocultivo tanto de enfermos ambulatorios como hospitalarios. Se toma el municipio como unidad de referencia para representar la distribucion espacial. Para el estudio de la tendencia se utiliza un modelo determinista multiplicativo, agrupando los datos en periodos cuatrisemanales Resultados: Se han recogido un total de 781 casos de infeccion por Salmonella y 654 casos de infeccion por Campylobacter, con unas tasas medias anuales de 95 y 79,5 × 10(5) habitantes respectivamente. La enteritis por Campylobacter se presenta mayoritariamente en menores de 5 anos (73,4 %), contra el 35,5 % para la salmonelosis. La situacion se invierte en el caso de porcentaje de ingreso hospitalario; asi, el ingreso por salmonelosis es casi 5 veces superior. Ambos generos presentan una clara estacionalidad, con un pico pronunciado en el mes de agosto. Conclusiones: Se observa una tendencia ascendente en el numero de aislamientos positivos para ambos microorganismos y una clara estacionalidad en la epoca estival.

[Investigation of a foodborne intoxication in a high-density penitentiary center].

BACKGROUND On September 25 2005, more than 100 inmates (almost 5% of the 1,800 prison population) experienced sudden onset gastroenteritis. This outbreak was the largest foodborne outbreak described in a prison population in Spain. Our objective was to confirm the outbreak, identify risk factors, implement control measures, and provide recommendations. METHODS We conducted a cohort analysis of a stratified random sample of all the inmates, a cohort analysis of the one of the prison blocks, and an environmental investigation. RESULTS A total of 221 inmates were selected, of which 196 were interviewed. Twenty-eight percent had gastroenteritis and the main symptoms were abdominal pain (85%) and diarrhea (71%). All foods consumed caused similar attack rates. Factors associated with the risk of illness were eating the entire portion of seafood cocktail at lunch or all of the fried shrimp at dinner on September 24 (RR = 2; 95% CI, 1.1-3.8, and RR = 1.8; 95% CI, 1.1-3.1). Analysis of one of the prison blocks yielded results similar to those of the random sample. Clostridium perfringens, Bacillus cereus and Escherichia coli were isolated from a sample of the seafood cocktail. CONCLUSION A gastroenteritis outbreak caused by several pa-thogens was confirmed. Both the reported symptoms and the calculated incubation periods corresponded to the pathogens isolated. Preparation of food in prison facilities should meet minimum safety standards, including refrigeration and training of food handlers.

Epidemiología descriptiva de meningitis no meningocócicas bacterianas de la provincia de Zaragoza (1999-2004): evaluación de su sistema de vigilancia

Objetivos: Describir las meningitis no meningococicas bacterianas (MnMB) y evaluar el Sistema de Vigilancia Epidemiologica (SVE) en la provincia de Zaragoza entre 1999 y 2004. Metodos: Se utilizo el registro de enfermedades de declaracion obligatoria (EDO) y el conjunto minimo basico de datos (CMBD). Se evaluo el SVE utilizando criterios de los Centers for Disease Control and Prevention, estimando la exhaustividad mediante captura-recaptura. Resultados: Se notificaron 111 casos de MnMB (62,2% en hombres). La edad media fue de 40,7 anos. La mayor proporcion de casos (16,5%) fue en ninos menores de 2 anos. La forma clinica en el 81,1% de los casos fue la meningitis; el 70,3% fue diagnosticada por cultivo. Aparecieron Streptococcus en el 54% de los casos (el 82% por S. pneumoniae), enterobacterias en el 5,4%, Lysteria y Staphylococcus en el 4,5%, Pseudomona aeruginosa en el 1,8%, y Haemophilus influenzae en el 0,9%. La incidencia por 100.000 habitantes fue entre 1,6 en 2004 y 2,6 en 2001. La letalidad fue del 7,3%. La exhaustividad del sistema EDO fue maxima en el ano 2001 (del 84,4%). La exhaustividad conjunta con CMBD fue superior al 85% y la oportunidad fue de 2 dias. La aceptabilidad del sistema fue buena, ya que el 75% de las variables estaban cumplimentadas en el 97% de las encuestas. Conclusiones: Se destaca la relevancia de la evaluacion del SVE en funcion de sus resultados. Las MnMB debidas a S. pneumoniae representan un grupo significativo y su letalidad es elevada. La exhaustividad del SVE en Zaragoza supera el 80%, al considerar EDO y CMBD. La incorporacion del CMBD en la vigilancia facilitaria una aproximacion a la incidencia real de algunas EDO.

Estimación del uso del cinturón de seguridad mediante un estudio de observación y una encuesta telefónica

Resumen Objetivo Estimar la prevalencia de usuarios del cinturon de seguridad mediante una encuesta telefonica y un estudio de observacion. Poblacion y metodos Observacion directa. Observadores entrenados previamente, estudiaron 4.067 usuarios de turismos particulares, en 10 intersecciones de Madrid, siguiendo las recomendaciones de la «National Highway Traffic Safety Administration». Encuesta telefonica Se estudiaron 433 usuarios de turismos particulares seleccionados a partir de la guia telefonica. El cuestionario fue cumplimentado por entrevistadores entrenados. Resultados La observacion directa registro una prevalencia de 58,5%, siendo superior en las intersecciones de trafico interurbano (OR = 2,1). En la encuesta telefonica, la prevalencia fue del 94% en el ambito interurbano y del 64% en el urbano y se asocio con no haber sido sancionado y tener una opinion positiva sobre su utilidad. Conclusiones La prevalencia observada es baja especialmente en el ambito urbano. La encuesta telefonica sobreestima el uso del cinturon, pero aporta informacion util para la planificacion.

[Descriptive epidemiology of non-meningococcal bacterial meningitis in the province of Saragossa [Spain] from 1999 to 2004. Evaluation of the Epidemiological Surveillance System].

OBJECTIVES To describe non-meningococcal bacterial meningitis (nMM) and to evaluate the Epidemiological Surveillance System (ESS) in the province of Saragossa (Spain) between 1999 and 2004. METHODS Information was obtained from the register of diseases subject to mandatory reporting and the Minimum Basic Data Set (MBDS). The ESS was evaluated by using the Centers for Disease Control and Prevention (CDC) criteria and by estimating the completeness of the system through the capture-recapture technique. RESULTS 111 cases of nMM were notified (62.2% in males) and the mean age was 40.7 years. The largest proportion of cases (16.5%) occurred in children under 2 years of age. The clinical presentation was meningitis in 81.1%. Diagnosis was through bacterial culture in 70.3%. Streptococcus sp. was found in 54% (82% due to S. pneumoniae), enterobacteria in 5.4%, Listeria and Staphylococcus in 4.5%, Pseudomonas aeruginosa in 1.8%, and Haemophilus influenzae in 0.9%. The incidence rate per 100,000 inhabitants was 1.6 in 2004 and 2.6 in 2001. The case fatality was 7.3%. The completeness of the mandatory reporting system reached a peak in 2004 at 84.4%. The combined completeness of the MBDS and the mandatory reporting system was above 85% and timeliness of reporting was 2 days. The acceptability of the system was high since 75% of all variables were complete in 97% of the questionnaires. CONCLUSION We highlight the importance of evaluation of the ESS, based on its results. nMM due to S. pneumoniae represent an important group of diseases and their case fatality is high. The completeness of the ESS in Saragossa was over 80% when the mandatory reporting system and the MBDS were combined. Incorporating the MBDS into surveillance would facilitate the estimation of the real incidence of various diseases subject to mandatory reporting.

Brote de gastroenteritis en turistas: limitaciones de información y respuesta

Background: We present the results of different studies performed in the investigation of a gastroenteritis outbreak and we describe the difficulties and limitations encountered during its study. Methods: Several analytical studies were designed: one cohort study and one case-control study with different samples sizes. Results: Of the 189 trip participants, 43% answered the questionnaire. Forty-five cases were identified. The factors significantly associated with the disease were: dinner in one of the restaurants of the resort on December 11 in all analytical studies and the excursion to a nearby island in the cohort study. Discussion: The outbreak was confirmed however due to the low response rate and the problems encountered to interview the participants in the trip, it was not possible to identify the route of transmission.Background We present the results of different studies performed in the investigation of a gastroenteritis outbreak and we describe the difficulties and limitations encountered during its study.

Gastroenteritis outbreak in tourists: limitations of information and response.

BACKGROUND We present the results of different studies performed in the investigation of a gastroenteritis outbreak and we describe the difficulties and limitations encountered during its study. METHODS Several analytical studies were designed: one cohort study and one case-control study with different samples sizes. RESULTS Of the 189 trip participants, 43% answered the questionnaire. Forty-five cases were identified. The factors significantly associated with the disease were: dinner in one of the restaurants of the resort on December 11 in all analytical studies and the excursion to a nearby island in the cohort study. DISCUSSION The outbreak was confirmed however due to the low response rate and the problems encountered to interview the participants in the trip, it was not possible to identify the route of transmission.