On 16 March 2018, a nursing home notified a possible acute gastroenteritis outbreak that affected 11 people. Descriptive and case-control studies and analysis of clinical and environmental samples were carried out to determine the characteristics of the outbreak, its aetiology, the transmission mechanism and the causal food. The extent of the outbreak in and outside the nursing home was determined and the staff factors influencing propagation were studied by multivariate analysis. A turkey dinner on March 14 was associated with the outbreak (OR 4.22, 95% CI 1.11-16.01). Norovirus genogroups I and II were identified in stool samples. The attack rates in residents, staff and household contacts of staff were 23.49%, 46.22% and 22.87%, respectively. Care assistants and cleaning staff were the staff most frequently affected. Cohabitation with an affected care assistant was the most important factor in the occurrence of cases in the home (adjusted OR 6.37, 95% CI 1.13-36.02). Our results show that staff in close contact with residents and their household contacts had a higher risk of infection during the norovirus outbreak.

Seasonal influenza is a cause of hospitalization, especially in people with underlying disease or extreme age, and its severity may differ depending on the types and subtypes of circulating viruses. We investigated the factors associated with ICU admission or death in hospitalized patients with severe laboratory-confirmed influenza according to the viral type and subtype. An observational epidemiological study was carried out in patients aged ≥18 years from 12 Catalan hospitals between 2010 and 2016. For each reported case we collected demographic, virological and clinical characteristics. A mixed-effects logistic regression model was used to estimate crude and adjusted ORs. 1726 hospitalized patients were included: 595 (34.5%) were admitted to the ICU and 224 (13.0%) died. Lower ICU admission was associated with age ≥75 years in all influenza types and subtypes and with age 65-74 years for type A. In contrast, the 65-74 and ≥75 years age groups were associated with an increased risk of death in all types and subtypes, especially for type B (aOR 27.42, 95% CI: 4.95-151.93 and 15.96; 95% CI: 3.01-84.68). The comorbidity most closely associated with severe outcomes was immune deficiency, which was associated with death for type B (aOR 9.02, 95% CI: 3.05-26.69) and subtype A(H1N1)pdm09 (aOR 3.16, 95% CI: 1.77-5.66). Older age was a differential factor for ICU admission and death: it was associated with lower ICU admission but a risk factor for death. The comorbidity with the closest association with death was immune deficiency, mainly in influenza type B patients.

Ten cases of chikungunya were diagnosed in Spanish travellers returning from Haiti (n=2), the Dominican Republic (n=7) or from both countries (n=1) between April and June 2014. These cases remind clinicians to consider chikungunya in European travellers presenting with febrile illness and arthralgia, who are returning from the Caribbean region and Central America, particularly from Haiti and the Dominican Republic. The presence of Aedes albopictus together with viraemic patients could potentially lead to autochthonous transmission of chikungunya virus in southern Europe.

OBJECTIVE: To determine the risk of latent tuberculous infection (LTBI) among contacts of smokers with tuberculosis (TB).METHODS: A study was conducted to determine the prevalence of LTBI among contacts of TB cases aged >14 years in Catalonia, Spain. A survey was carried out for each TB case and their contacts. LTBI was diagnosed using the tuberculin skin test (>= 5 mm). The risk of LTBI associated with smoking was determined by multivariate logistic regression analysis, with adjusted odds ratio (aOR) and their 95% confidence intervals (CI).RESULTS: The smoking prevalence among TB cases was 40.7% (439/1079). The prevalence of LTBI among their contacts was 29.7% (2281/7673). It was higher among contacts of smoking index cases (35.3%) than among those of non-smokers (25.7%). Smoking was independently associated with an increased risk of LTBI among contacts (aOR 1.5, 95 %CI 1.3-1.7), and was estimated to be responsible for 12.8% of infections.CONCLUSIONS: Index case smoking increases the risk of LTBI and should be systematically investigated. A reduction in smoking could lower the risk of infection substantially.

Infectious acute gastroenteritis (AGE) is a major health problem worldwide. Salmonella is a leading cause of AGE outbreaks, but viruses may be responsible for up to 80% of cases. We compared the frequency and characteristics of AGE out breaks in Catalonia due to norovirus and Salmonella and the changes in these outbreaks from 2000 through 2010. In 2006 through 2010, we also investigated the distribution by season, setting, and implicated food, the incidence rates of cases associated, and the hospitalization rates. Differences in proportions were estimated by Pearson's chi-square test, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. In 2000 through 2010, the number of AGE outbreaks caused by Salmonella decreased and those caused by norovirus significantly increased. From 2006 onward, norovirus was the most common etiology in AGE outbreaks, but in foodborne outbreaks, Salmonella was the more common cause until 2010. The incidence rate per 10(5) inhabitants was greater for norovirus (20.81 versus 3.97, P < 0.001), and the hospitalization rate was lower for norovirus (0.84 versus 4.69, P < 0.001). Salmonella infections occurred more frequently in the warmer months, and norovirus infections were more common in the colder months, both in terms of total outbreaks (OR = 4.50; 95% CI, 2.85 to 7.11; P < 0.001) and foodborne outbreaks (OR = 4.38; 95% CI, 2.42 to 7.95; P < 0.001). Norovirus infections were less common in private homes (OR = 0.08; 95% CI, 0.04 to 0.14; P < 0.001) and more common in nursing homes (P < 0.001) and hospitals or long-term care facilities (OR = 14.09; 95% CI, 3.35 to 59.33; P < 0.001). Foods most frequently implicated in norovirus infection outbreaks were seafood (22% ; OR = 7.89; 95% CI, 2.59 to 24.3; P < 0.001), and those most common in Salmonella infection outbreaks were mayonnaise and similar items (30.2%; OR = 0.05; 95% CI, 0.01 to 0.22; P < 0.001). Foodborne outbreaks in which the vehicle was not identified were more frequent in cases of norovirus infection (OR = 4.59; 95% CI, 2.54 to 8.30; P < 0.001). Our results indicate that norovirus rather than Salmonella is the most common cause of AGE outbreaks in Catalonia. Foodborne AGE outbreaks were more commonly caused by norovirus than by Salmonella only in 2010, the last year of the study.

Botulism is a severe neuroparalytic disorder that can be potentially life-threatening. In Barcelona, Spain, no outbreaks had been reported in the past 25 years. However, in September 2011, two outbreaks occurred involving two different families. A rare case of Clostridium baratii which produced a neurotoxin F outbreak was detected in five family members who had shared lunch, and several days before that another family was affected by C. botulinum toxin A which was probably present in homemade pâté.

In 2000, the circulation of indigenous measles was interrupted in Catalonia as a result of the activities of the elimination programme introduced in 1991. However, various transmission chains occurred in the indigenous population after the introduction of an imported case, and this caused a total change in the existing situation of elimination. The objective of this study was to analyze the epidemiological and clinical characteristics of the measles outbreak in Catalonia in 2006. Cases reported between August 28 2006 and July 8 2007 were collected. Cases were microbiologically confirmed by determination of measles-specific IgM and/or detection of the viral genome in urine samples. A total of 381 cases of measles were confirmed, representing an incidence of 6.6 per 100,000 inhabitants. Laboratory confirmation was made in 87.1% of the cases and all specimens sequenced belonged to the D4 genotype. A total of 89.5% of the cases occurred in non-vaccinated people, above all in infants aged <16 months.

From 1 October 2006 to 31 January 2007, 213 confirmed cases of measles occurred in the Barcelona Region, resulting from the importation of one case.

A community outbreak of Legionella pneumonia in the district of Cerdanyola, Mataró (Catalonia, Spain) was investigated in an epidemiological, environmental and molecular study. Each patient was interviewed to ascertain personal risk-factors and the clinical and epidemiological data. Isolates of Legionella from patients and water samples were subtyped by pulsed-field gel electrophoresis. Between 7 August and 25 August 2002, 113 cases of Legionella pneumonia fulfilling the outbreak case definition criteria were reported, with 84 (74%) cases being located within a 500-m radius of the suspected cooling tower source. In this area, the relative risk of being infected was 54.6 (95% CI 25.3-118.1) compared with individuals living far from the cooling tower. Considering the population residing in the Cerdanyola district (28,256 inhabitants) as a reference population, the attack rate for the outbreak was 399.9 cases/100,000 inhabitants, and the case fatality rate was 1.8%. A single DNA subtype was observed among the ten clinical isolates, and one of the subtypes from the cooling tower matched exactly with the clinical subtype. Nine days after closing the cooling tower, new cases of pneumonia caused by Legionella ceased to appear. The epidemiological features of the outbreak, and the microbiological and molecular investigations, implicated the cooling tower as the source of infection.

A possible case of rubella in a 24 year old woman in her eighth week of pregnancy was reported in the Barcelona region on 21 November 2005

STUDY OBJECTIVES The objective of this study was to evaluate the effectiveness of a mass vaccination programme carried out in Catalonia (Spain) in the last quarter of 1997 in response to an upsurge of serogroup C meningococcal disease (SCMD). DESIGN Vaccination coverage in the 18 month to 19 years age group was investigated by means of a specific vaccination register. Vaccination effectiveness was calculated using the prospective cohort method. Cases of SCMD were identified on the basis of compulsory reporting and microbiological notification by hospital laboratories. Vaccination histories were investigated in all cases. Unadjusted and age adjusted vaccination effectiveness referred to the time of vaccination and the corresponding 95% confidence intervals (CI) were estimated at 6, 12, 18 and 24 months of follow up. SETTING All population aged 18 months to 19 years of Catalonia. MAIN RESULTS A total of seven cases of SCMD were detected at six months of follow up (one in the vaccinated cohort), 12 cases at 12 months (one in the vaccinated cohort), 19 cases at 18 months (two in the vaccinated cohort) and 24 at 24 months (two in the vaccinated cohort). The age adjusted effectiveness was 84% (95%CI 30, 97) at six months, 92% (95%CI 63, 98) at 12 months, 92% (95% CI 71, 98) at 18 months and 94% (95%CI 78, 98) at 24 months. In the target population, cases have been reduced by more than two thirds (68%) two years after the vaccination programme. In the total population the reduction was 43%. CONCLUSION Vaccination effectiveness has been high in Catalonia, with a dramatic reduction in disease incidence in the vaccinated cohort accompanied by a relevant reduction in the overall population. Given that vaccination coverage was only 54.6%, it may be supposed that this vaccination effectiveness is attributable, in part, to the herd immunity conferred by the vaccine.

En 1994 el Departamento de Sanidad y Seguridad Social (DSSS) inició un programa de vacunación antigripal que dirigió a grupos de alto riesgo de padecer la gripe o sufrir sus complicaciones. Este programa supuso un incremento de la actividad vacunal que hasta esta fecha se desarrollaba básicamente en el ámbito privado y laboral. En este trabajo se presenta la cobertura de la vacunación antigripal en Cataluña así como un estudio para describir la población vacunada. El estudio para describir la población vacunada se realizó a partir de una muestra telefónica, representativa de la población total de Cataluña. De la encuesta vacunal se deduce una cobertura poblacional del 24,6 ± 1,4. Un tercio de esta vacunación corre a cargo de las mutualidades laborales y de las farmacias que las dispensan de forma privada. Los dos tercios restantes las proporciona la administración. La implantación del programa de vacunación antigripal es capaz de prevenir un importante número de casos en el país, aunque éste es susceptible de ser mejorado. Una mejora de la efectividad del programa se lograría, principalmente, incidiendo sobre la adhesión de los individuos que se niegan a vacunar. In 1994, the Department of Health and Social Security (DHSS) began a program of influenza vaccination aimed at groups with a high risk of suffering influenza and its complications. This program supposed an increase in vaccination activity, which until that time was carried out mainly in private clinics or in the work-place. This study analyses the coverage of influenza vaccination in Catalonia and a description of the vaccinated population. The study of the vaccinated population was carried out by a telephone sample representative of the total population of Catalonia. The vaccination survey shows a population coverage of 24.6 ± 1.4. One-third of vaccinations are covered by private health insurance in the workplace and by private prescriptions by chemists. The remaining two-thirds are administered by the public administration. Implementation of an influenza vaccination program can prevent a substantial number of cases in Catalonia although the results obtained could be improved upon. Greater effectiveness could be achieved mainly by assuring the participation of individuals who refuse vaccination.

Como consecuencia de las altas coberturas vacunales alcanzadas en estos últimos años, algunas enfermedades vacunables se han eliminado y otras han disminuido sus incidencias de manera muy importante. En estas circunstancias, la actividad vacunal puede entrar en crisis y los programas de reacciones adversas a vacunas adquirir un protagonismo importante. La Dirección General de Salud Pública empezó en 1999 un programa de prevención de reacciones adversas a vacunas para conocer su dimensión, abordar su tratamiento y planificar su prevención. En este trabajo se presentan los resultados obtenidos durante este primer año de programa. Para el desarrollo de este programa se ha creado un registro que recoge datos epidemiológicos y clínicos. La comparación de la reactogenicidad de los distintos tipos de vacuna se ha llevado a cabo con el cálculo del riesgo relativo y para medir la responsabilidad de la vacuna antidiftérica, antitetánica y antipertúsica de pared completa (DTPw) en la aparición de las reacciones adversas, se calculó el riesgo atribuible y su fracción etiológica. Durante 1999 se declararon 283 individuos que presentaron 415 reacciones vacunales. Éstas incidieron principalmente en las primo vacunaciones (primeros dos años de vida), en las vacunas que en su composición contenía el antígeno tetánico y también en las vacunas con el componente pertúsico de células enteras. Las vacunas combinadas no mostraron mayor reactogenicidad que aquellas formadas por vacunas de un solo componente. Cuando los programas de vacunación consiguen disminuir de una manera importante la incidencia de las enfermedades en un área, la percepción de su gravedad disminuye y tiende a valorarse los riesgos asociados a la vacunación. En estos momentos, el conocimiento de las reacciones adversas a vacunas que nos acompañan adquiere una importancia capital para poder abordar su prevención y tratamiento correcto. In recent years, some vaccine-preventable diseases have been eliminated while in others the incidence has been substantially reduced due to the high levels of vaccine coverage that have been reached. In these circumstances, while vaccination activity may decrease, the problem of adverse vaccine reactions can become much more important. For this reason, the General Directorate of Public Health of the Autonomous Government of Catalonia began a programme for the prevention of adverse vaccine reactions in 1999, with the objectives of measuring the dimension of the problem, encountering a strategy for treatment and planning prevention measures. The present article presents the results obtained after one year of the programme. A register was created to collect clinical and seroepidemiological data. The reactogenicity of the different vaccines was compared by calculating the relative risk. To measure the number of adverse reactions caused by the DTPw vaccine, the attributable risk and its etiological fraction were calculated. During 1999, 283 subjects presenting 415 adverse vaccine reactions were reported. Reactions were reported principally in the primovaccination age group (under 2 years), in vaccines containing the tetanus antigene, and also in vaccines containing a whole-cell pertussis component. Combined vaccines did not show greater reactogenicity than single-component vaccines. When vaccination programmes substantially reduce disease incidence in a region, the perception of the severity of the disease decreases while that of the risks associated with vaccination increases. In this situation, knowledge of the characteristics of adverse vaccine reactions is vitally important in order to correctly treat and prevent them.

Objective:To assess the impact of HIV/AIDS on the incidence of tuberculosis (TB) and to analyse the determinants of TB presenting as the first indicative disease of AIDS. Design:Analysis of TB and AIDS surveillance data. Setting:Catalonia, north-east Spain. Patients:Two separate sources were used: (i) TB cases reported to the Catalan TB registry diagnosed between January 1982 and December 1993; (ii) AIDS cases reported to the AIDS Catalan registry diagnosed between January 1982 and December 1994. Main outcome measures:Expected and observed TB cases, and number and characteristics of AIDS cases presenting with TB. Results:From 1987 to 1993 the annual TB crude incidence rate increased by 50% to a rate of 49.7 per 100 000, with at least 60% of the increase directly due to AIDS. During that period specific rates among children aged 0–4 years remained high at around 40 per 100 000. A total of 7010 AIDS cases were diagnosed between 1988 and 1994, of whom 24.3% had TB. Multivariate analysis from those AIDS cases showed that besides male sex, young age, and urban residence, the strongest predictors of TB among AIDS cases were history of imprisonment (odds ratio, 2.16; P < 0.001) and intravenous drug use (odds ratio, 1.65; P < 0.001). Conclusions:The high rates of TB among children and young adults suggest that TB transmission has increased during this period, especially among people at high risk of AIDS. The determinants of individual risk of TB among AIDS patients act together, especially in prisons. The HIV/TB coepidemic is an emerging threat potentially for all and requires expanding targeted measures to prevent and control both diseases in our setting.