Cases of legionellosis sometimes arise in the form of aggregations which are difficult to interpret. This study provides an analysis of these groupings having arisen one summer in Castellon.
...Microbiological, clinical and epidemiological field methods were employed.
Within a few days, there were five (5) cases of legionella pneumonia in workers related to various ceramic industries within an area where a large number of these plants are located. Two constituted a minor outbreak. By means of molecular biology techniques performed on the strains, the common origins of three of the cases were ruled out.
It is debated whether this episode of an outbreak having arisen within the context of a broader-ranging cluster of cases of a multi-focal origin was a chance event or whether it was the manifestation of a risk related to this industrial activity which might repeat itself.
We describe the interventions carried out in a local epidemiology unit related to the epidemiology of gastroenteritis due to norovirus in geriatric homes in Castellón (Spain) during several years. ...These range from various outbreaks in the same geriatric home to the study of sporadic cases which determine the endemic situation. This study focuses on the analysis of this endemic situation of digestive symptoms in silent epidemic periods and proposes a simple method to detect the initiation of GEA of progressive transmission (person-person) which we call System of Detection by Prevalence Threshold (SiDUP). The epidemiological spectrum of gastroenteritis due to norovirus in geriatric homes is discussed.
OBJETIVOS: Estimar factores de riesgo de síntomas de rinitis alérgica en adolescentes de Castellón, España. MÉTODOS: Estudio transversal de base poblacional a partir de la fase III del ISAAC ...(International Study of Asthma and Allergies in Childhood) llevado a cabo en 2002 entre adolescentes de 13 a 14 años. Se utilizó el cuestionario ISAAC para definir los casos de rinitis alérgica. Se estimaron razones de posibilidades (RP) y sus intervalos de confianza de 95% (IC95%) mediante modelos de regresión logística. RESULTADOS: La participación fue de 66,8% (3 995 adolescentes de un total de 5 981). La prevalencia de síntomas de rinoconjuntivitis en los últimos 12 meses fue de 16,5%, y la prevalencia de alergia nasal alguna vez, de 7,4%. Con la regresión logística, la rinoconjuntivitis se asoció a la mujer (RP=1,63; IC95%:1,33-2,00); fumar la madre en casa (RP=1,32; IC95%:1,08-1,63); historia de sinusitis (RP=2,02; IC95%:1,51-2,70), y circulación constante de camiones por la calle de residencia (RP=1,58; IC95%:1,02-2,44). De igual manera, la alergia nasal se asoció con la historia familiar de rinitis alérgica (RP=2,62; IC95%:1,90-3,63); historia de sinusitis (RP=2,65; IC95%:1,77-3,96), historia de bronquitis (RP=1,68; IC95%:1,19-2,36), y clase social, con descensos progresivos al comparar las clases superiores e inferiores. CONCLUSIONES: Diferentes factores de riesgo medioambientales se asociaron con el hecho de sufrir síntomas de alergia nasal; se sugiere la importancia de adecuar medidas preventivas específicas.
To estimate the risk factor for symptoms of allergic rhinitis in adolescents in Castellón, Spain.
A cross-sectional population based study of Phase III of the International Study of Asthma and ...Allergies in Childhood (ISAAC) conducted in 2002 among adolescents from 13-14 years of age. The ISAAC questionnaire was used to define cases of allergic rhinitis. Logistic regression models were used to estimate odds ratio (OR) and their 95% confidence intervals (95%CI).
Participation was 66.8% (3,995 adolescents of the 5,981 total). The prevalence of rhinoconjunctivitis symptoms in the last 12 months was 16.5% and the prevalence of nasal allergy at some point was 7.4%. Logistic regression showed that rhinoconjunctivitis was associated with being female (OR = 1.63; 95%CI: 1.33-2.00); a mother who smokes in the home (OR = 1.32; 95%CI: 1.08-1.63); a history of sinusitis (OR = 2.02; 95%CI: 1.51-2.70); and living on a street with heavy truck traffic (OR = 1.58; 95%CI: 1.02-2.44). Likewise, nasal allergy was associated with a family history of allergic rhinitis (OR = 2.62; 95%CI: 1.90-3.63); a history of sinusitis (OR = 2.65; 95% CI: 1.77-3.96); a history of bronchitis (OR = 1.68; 95%CI: 1.19-2.36); and social class, with a steady decline when comparing higher classes to lower classes.
Various environmental risk factors were associated with the symptoms of nasal allergies, which points to the importance of implementing specific preventive measures.
Background. There are few studies about the effect of alcoholic beverages in food-borne disease outbreaks. Methods. We studied this effect during an outbreak of Salmonella ohio infection that ...occurred in Castellón (Spain) in May 2000. S. ohio was isolated in stools of patients and also in implicated foods. Results. Analysis was restricted to the group that was exposed to contaminated food (51 persons). We compared attack rates by level of alcohol intake (none, 1-40 gm, and >40 gm). The adjusted relative risks in the two alcohol categories were 0.73 95% confidence interval (CI) = 0.46-1.15 and 0.54 (95% CI = 0.31-0.96), respectively. Conclusions. We discuss the possible protective effect of alcoholic beverages in some food-borne infectious outbreaks.
We intended to estimate the prevalence of reactive arthritis (ReA) and other musculoskeletal sequelae after a foodborne outbreak of Salmonella enteritidis phago type 14 b in a banquet in Castellón in ...June 5th, 2004.
A prospective cohort study was carried out with 125 subjects (90.6%) out of the banquet participants. Sixty-two symptomatic infected cases occurred, 33 with positive cultures of S. enteritidis phago type 14 b, and 54 non-infected subjects. After 4 months of the outbreak, all 125 subjects were studied by means of a symptoms questionnaire of ReA based on Buxton et al, administered by telephone. Medical examination of subjects with musculoskeletal symptoms, 29 of 30, was done by a rheumatologist. Relative risk (RR) with 95% confidence interval (CI) was estimated by Poisson regression models.
Any symptoms were reported by 32 (52%) of infected cases versus 13 (24%) of non-infected (RR adjusted = 2.49; 95% CI, 1.26-4.95); 20 (32%) infected cases reported muskuloskeletal symptoms compared to 4 (7%) non-infected (RR adjusted = 4.96; 95% CI, 1.64-15.04). The medical examination of the subjects with musculoskeletal symptoms revealed 3 infected cases with ReA (4.8%; 3/62). In addition, several reactive musculoskeletal sequelae associated with salmonellosis infection were found in 4 subjects (1 neck pain, 1 polyarthralgias, and 2 enthesopathy).
The occurrence of ReA was lower than other studies but the incidence of musculoskeletal symptoms was increased. The infection by Salmonella supposes a risk for joint symptoms that could be important taking into account the high incidence of salmonellosis.
Few studies have evaluated the association between preexisting vitamin D deficiency and incident tuberculosis (TB). We assessed the impact of baseline vitamins D levels on TB disease risk.
We ...assessed the association between baseline vitamin D and incident TB in a prospective cohort of 6,751 HIV-negative household contacts of TB patients enrolled between September 1, 2009, and August 29, 2012, in Lima, Peru. We screened for TB disease at 2, 6, and 12 months after enrollment. We defined cases as household contacts who developed TB disease at least 15 days after enrollment of the index patient. For each case, we randomly selected four controls from among contacts who did not develop TB disease, matching on gender and year of age. We also conducted a one-stage individual-participant data (IPD) meta-analysis searching PubMed and Embase to identify prospective studies of vitamin D and TB disease until June 8, 2019. We included studies that assessed vitamin D before TB diagnosis. In the primary analysis, we defined vitamin D deficiency as 25-(OH)D < 50 nmol/L, insufficiency as 50-75 nmol/L, and sufficiency as >75nmol/L. We estimated the association between baseline vitamin D status and incident TB using conditional logistic regression in the Lima cohort and generalized linear mixed models in the meta-analysis. We further defined severe vitamin D deficiency as 25-(OH)D < 25 nmol/L and performed stratified analyses by HIV status in the IPD meta-analysis. In the Lima cohort, we analyzed 180 cases and 709 matched controls. The adjusted odds ratio (aOR) for TB risk among participants with baseline vitamin D deficiency compared to sufficient vitamin D was 1.63 (95% CI 0.75-3.52; p = 0.22). We included seven published studies in the meta-analysis and analyzed 3,544 participants. In the pooled analysis, the aOR was 1.48 (95% CI 1.04-2.10; p = 0.03). The aOR for severe vitamin D deficiency was 2.05 (95% CI 0.87-4.87; p trend for decreasing 25-(OH)D levels from sufficient vitamin D to severe deficiency = 0.02). Among 1,576 HIV-positive patients, vitamin D deficiency conferred a 2-fold (aOR 2.18, 95% CI 1.22-3.90; p = 0.01) increased risk of TB, and the aOR for severe vitamin D deficiency compared to sufficient vitamin D was 4.28 (95% CI 0.85-21.45; p = 0.08). Our Lima cohort study is limited by the short duration of follow-up, and the IPD meta-analysis is limited by the number of possible confounding covariates available across all studies.
Our findings suggest vitamin D predicts TB disease risk in a dose-dependent manner and that the risk of TB disease is highest among HIV-positive individuals with severe vitamin D deficiency. Randomized control trials are needed to evaluate the possible role of vitamin D supplementation on reducing TB disease risk.
To examine the potential association between vitamin D (VitD) deficiency and latent tuberculosis infection (LTBI) and its effect on TB infection conversion (TBIC) incidence.
We carried out a ...cross-sectional and prospective cohort study of nine pulmonary TB cases that occurred in 2015-2016 in five nursing homes and one mental disability institution in Castellon, Spain. QuantiFERON
-TB Gold and the tuberculin skin test were used to detect LTBI and TBIC, respectively. Serum 25-hydroxyvitamin D was measured using chemiluminescence immunoassay. Poisson regression and inverse probability weighting were used for statistical analyses.
The study included 448 residents, 341 staff members with 48 relatives of TB cases (participation rate 82%): of these, respectively 122 (27.2%), 37 (10.9%) and 7 (14.6%) were LTBI-positive; and respectively 22 (7.7%), 10 (3.8%) and 1 (3.7%) were TBIC-positive. LTBI was not associated with VitD status. Severe VitD deficiency (SVDD; defined as VitD level < 10 ng/ml), found in 45.1% of residents, as well as VitD levels of <30 ng/ml (aRR 10.41 95% CI 1.48-73.26), were associated with increased TBIC risk (adjusted relative risk aRR 12.1, 95% CI 1.51-97.10), suggesting SVDD as a threshold effect.
Severe VitD deficiency is a TBIC risk factor.
El proyecto EMECAM constató el efecto a corto plazo de la contaminaci
ón atmosférica sobre la mortalidad en 14 ciudades españolas
entre 1990 y 1995. El Estudio Multicéntrico Español de Contaminaci
ón ...Atmosférica y Salud (EMECAS) amplía estos objetivos
incorporando al análisis datos de morbilidad hospitalaria, utiliza
información más reciente y suma un total de 16 ciudades. Se trata de
un estudio ecológico de series temporales, siendo las variables respuesta
las defunciones diarias y los ingresos hospitalarios urgentes
por enfermedades del aparato circulatorio y enfermedades respiratorias
en los residentes de cada ciudad. Contaminantes analizados: part
ículas en suspensión, SO2, NO2, CO y O3. Variables de control:
meteorológicas, de calendario, estacionalidad y tendencia e incidencia
de gripe. Análisis estadístico: estimación de la asociación en cada
ciudad mediante la construcción de modelos de regresión de Poisson
aditivos generalizados, y meta-análisis para la obtención de estimadores
conjuntos. Los niveles medios de contaminantes se situaron por debajo de los establecidos por la normativa actual para el dióxido
de azufre, el monóxido de carbono y el ozono. Los valores de NO2
y PM10 se situaron alrededor de los establecidos en la normativa (40
mg/m3). Se trata del primer estudio de la relación entre contaminaci
ón atmosférica y morbilidad en un conjunto de ciudades españolas.
Los niveles de contaminantes estudiados son moderados para algunos
contaminantes, aunque en otros, especialmente NO2 y partículas,
podrían representar un problema para el cumplimiento de la normativa
vigente.
PDF
