Laura García-García

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.

Different vaccination strategies in Spain and its impact on severe varicella and zoster

Varicella vaccines available in Spain were marketed in 1998 and 2003 for non-routine use. Since 2006 some regions decided to include varicella vaccination in their regional routine vaccination programmes at 15-18 months of age. Other regions chose the strategy of vaccinating susceptible adolescents. This study shows the trends in severe varicella zoster virus infections through the analysis of the hospital discharges related to varicella and herpes zoster in the general population from 2005 to 2010 in Spain. A total of 11,125 hospital discharges related to varicella and 27,736 related to herpes zoster were reported during the study period. The overall annual rate of hospitalization was 4.14 cases per 100,000 for varicella and 10.33 cases per 100,000 for herpes zoster. In children younger than 5 years old varicella hospitalization rate significantly decreased from 46.77 in 2005 to 26.55 per 100,000 in 2010. The hospitalization rate related to herpes zoster slightly increased from 9.71 in 2005 to 10.90 per 100,000 in 2010. This increase was mainly due to the significant increase occurring in the >84 age group, from 69.55 to 97.68 per 100,000. When gathering for regions taking into account varicella vaccine strategy, varicella related hospitalizations decreased significantly more in those regions which included the vaccine at 15-18 months of age as a routine vaccine comparing with those vaccinating at 10-14 years old. No significant differences were found in herpes zoster hospitalization rates regarding the varicella vaccination strategy among regions. Severe varicella infections decreased after implementation of varicella vaccination in Spain. This decrease was significantly higher in regions including the vaccine at 15-18 months of age compared with those vaccinating susceptible adolescents.

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.

Seroprevalence of antibodies against measles, rubella, mumps, varicella-zoster, and B. Pertussis in young adults of Madrid, Spain.

In recent years, there has been an increase in the number of cases of certain immunopreventable diseases in our country. A high proportion of these have been recorded among the young adult population. The aim of this study was to determine the seroprevalence of antibodies against immunopreventable diseases with the greatest health impacts on the young adult population (19–39 y of age) in Madrid. We collected a total of 1,153 serum samples from healthy volunteers undergoing routine medical visits and used ELISA to determine the presence of IgG antibodies against measles, rubella, mumps, and varicella zoster, as well as Bordetella pertussis. The Pearson’s χ2 test was used to compare prevalences, the Mann-Whitney U test was used to compare means, and the Kruskal-Wallis test was applied for variables with more than 2 categories. Statistical significance was achieved with p values of < 0.05. The global prevalence of antibodies was 92.1% for measles, 94.4% for rubella, 88.3% for mumps, 92.8% for varicella zoster, and 70.2% for B. pertussis. No statistically significant differences were found between genders. The prevalence of antibodies against measles was more than 95% in the group of individuals born after 1986, and the percentage of individuals susceptible to rubella was less than 5% in women born after 1986. In spite of adequate vaccination coverage, in our region, a population of young adults exists who have not achieved the objectives of the WHO for the elimination of measles and congenital rubella syndrome.

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.

Varicella vaccination coverage inverse correlation with varicella hospitalizations in Spain

Varicella vaccines available in Spain were marketed in 1998 and 2003 for non-routine use. Since 2006 some regions included universal varicella vaccination in their regional routine vaccination programs at 15-18 months of age. Regions without universal vaccination in toddlers, but instead with the strategy of vaccinating susceptible adolescents, reached different varicella vaccination coverage through private market. This study shows the correlation between severe varicella zoster virus infections requiring hospitalization and the varicella vaccination coverage by region. A total of 3009 hospital discharges related to varicella were reported in 2009-2010. The overall annual rate of hospitalization was 3.27 cases per 100,000. In children younger than 5 years old varicella hospitalization rate was 30.73 cases per 100,000. Varicella related hospitalizations were significantly lower in the regions with universal vaccination. In those regions without universal vaccination at 15-18 months of age, those with higher coverage in private market showed lower hospitalization rates.

Epidemiology of hospitalizations due to syphilis in large urban areas in Spain between 1997 and 2006.

OBJECTIVE To describe the epidemiology and trends of hospitalizations due to syphilis over a ten-year period (1997-2006) in Madrid, Spain. METHODS Retrospective study using data provided by the National Epidemiology Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos; CMBD). Hospitalized patients suffering from syphilis were identified through the corresponding ICD-9-CM codes (090-097). RESULTS Between 1997 and 2006, 1265 hospitalizations related to syphilis were recorded in Madrid. The annual hospitalization rate was 2.3 per 100,000 inhabitants, the mortality rate was 0.09 per 100,000 inhabitants, and the case fatality rate was 4.03%. The rate of hospitalization and the case fatality rate were significantly higher among men and patients over the age of 80 years. CONCLUSION We found a significant increase in hospitalization rates during study period. Syphilis continues to be an important public health problem in Madrid, especially among men. Policies designed to control the course and transmission of sexually transmitted diseases needs to be improved.

Epidemiology of gonorrhoea-related hospitalisations in Spain between 1997 and 2006.

OBJECTIVE The prevalence of gonorrhoea has increased worldwide in the last few years. Gonorrhoea is one of the most common sexually transmitted infections (STIs) in the world, and is a serious public health problem because of its associated morbidity and complications. The objective of this study was to estimate the frequency of gonorrhoea-related hospitalisations in Spain between the years 1997 and 2006. STUDY DESIGN A retrospective epidemiological study was conducted using data from the National Epidemiological Surveillance System (Minimum Data Set [MDS]), where all of the gonorrhoea-related hospitalisations that occurred in Spain during this period were analysed. We calculated the general hospitalisation rates, mortality, case-fatality rate, and length of stay by gender and age. RESULTS During the course of the study, 928 hospitalisations occurred with a discharge diagnosis of gonorrhoea infection (International Classification of Diseases, 9th Revision, Clinical Modification: ICD 9 CM 098.0-098.89 at any diagnostic position), which represented a hospitalisation rate of 0.23 per 100,000 population, a mortality rate of 0.008 per 100,000 population, and a case-fatality of 3.77%. The main suspected causes of death were staphylococcal and streptococcal infections, malignant neoplasm and chronic diseases. The greatest hospitalisation rate was observed in children between the ages of 0 and 4years. CONCLUSIONS The gonorrhoea-related hospitalisation rate in Spain remained constant during the period of the study. A better understanding of the epidemiology of gonorrhoea will allow for the creation of effective preventive measures that will lead to a reduction in the number of new infections.

Hospitalizaciones relacionadas con infección gonocócica en la Comunidad de Madrid: 1997–2006

OBJECTIVE Gonorrhoea is one of the most frequent sexually transmitted diseases in the world. It is a serious problem due to its morbidity, complications and associated sequelae. This study aims to estimate the frequency of hospitalisations due to gonococcal infection in Madrid between 1997 and 2006. METHOD A retrospective epidemiological study was performed using data from the National Epidemiological Surveillance System for hospital data (Minimum Basic Data Set, [MBDS]). All hospitalisations related to gonococcal infection in Madrid were analysed. Information on hospitalisation rates, mortality, fatality and stay were obtained and gathered by year, sex and age. RESULTS During this study period, 113 hospitalisations related to gonococcal infection were recorded (Spanish Version of the International Classification of Diseases, 9th Revision, Clinical Modification: ICD-9-CM codes 098.0 and 098.89, any diagnostic position) representing a hospitalisation rate of 0.21 per 100,000, mortality rate of 0.02 per 100,000 people and case-fatality rate of 9.73%. An increased rate of hospitalisation in children up to 4 years and adults older than 65 years was observed. CONCLUSION The hospitalisation rate in patients with gonococcal infection has decreased in recent years, but it is important to continue with existing public health and control policies and create new ones to reduce these figures.