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MuV caused three epidemic waves in Spain since genotype G emerged in 2005, despite high vaccination coverage. SH gene sequencing according to WHO protocols allowed the identification of seven relevant variants and 88 haplotypes. While the originally imported MuVi/Sheffield.GBR/1.05/-variant prevailed during the first two waves, it was subsequently replaced by other variants originated by either local evolution or importation, according to the additional analysis of hypervariable NCRs. The time of emergence of the MRCA of each MuV variant clade was concordant with the data of the earliest sequence. The analysis of Shannon entropy showed an accumulation of variability on six particular positions as the cause of the increase on the number of circulating SH variants. Consequently, SH gene sequencing needs to be complemented with other more variable markers for mumps surveillance immediately after the emergence of a new genotype, but the subsequent emergence of new SH variants turns it unnecessary.

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This study reviews non-typhoid Salmonella (NTS)-related hospitalisations at National level in Spain between 2010 and 2015. NTS hospitalisations were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalisations was performed, including hospitalisation rates (HR) and case-fatality rates (CFR%) calculation. For those with NTS as Main Diagnosis logistic regression were used to estimate the relationship between the different factors and death outcome. 21,660 registered NTS-related hospitalisations were described (88.8% with Salmonella coded as Main Diagnosis). Average HR2010-2015 was 7.7 (range, 7.3 to 8.1) hospitalisations/100,000 population. Those with NTS infections as Secondary Diagnosis were on average (p < 0.001) older (47.9 vs. 36.5 years), presented worse Charlson Comorbidity Index (2.1 vs. 1.2), higher CFR% (4.8% vs. 0.7%), spent more days hospitalised (15.1 vs. 5.8 days), and generated more costs (6173 vs. 4272 euros/per hospitalisation) than those with NTS as Main Diagnosis. For those with NTS as Main Diagnosis increased risk of death was related to being > 64 years old (OR = 20.99; p < 0.001); presenting septicaemia (OR = 15.82; p < 0.001) or localised infections (OR = 3.98; p = 0.061); Charlson Comorbidity Index > 3 (OR = 4.57; p < 0.001); a non-HIV co-infection (OR = 1.80; p = 0.013); other risk factors (OR = 5.70; p < 0.001); bowel perforation (OR = 70.30; p < 0.001); or acute renal failure (OR = 1.95; p = 0.001). In those with Salmonella as Main Diagnosis, among all complications, bowel perforation presented the strongest association with death outcome. Clinical practice guidelines can help to identify patients at risk of bowel perforation to reduce the fatality of the disease.

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INTRODUCTION: Pertussis is a communicable disease that primarily affects infants. Vaccination has led to an important reduction in the incidence of the disease, however, resurgence of the disease has been observed. This study aimed to analyze the incidence of pertussis and assess the vaccination effectiveness (VE) of different schedules of acellular pertussis vaccination in the community of Madrid. METHODS: Pertussis cases notified to the Mandatory Disease Reporting System from 1998 to 2015 were analyzed. Five comparison periods were created: 1998-2001 (reference), 2002-2005, 2006-2009, 2010-2012 and 2013-2015. The incidence ratio (IR) between inter-epidemic periods was analyzed using a Poisson regression. VE was calculated using the screening method. Vaccine status data were collected from the vaccine registry. RESULTS: In total, 3855 cases were notified. Inter-epidemic periods were observed every 3-4 years. The incidence increased (IR: 5.99, p < 0.05) in the 2013-2015 period, particularly among infants younger than 1 month (IR: 32.41, p < 0.05). Vaccination data were available in 89% of cases. For those receiving the last dose at ≤6-month VE was 89.9% (95% confidence interval (CI): 87.3-92.0) after one year of follow-up, and 85.5% (95% CI: 82.4-88.1) after 11 years of follow-up. For those receiving the last dose at 18-months VE decreased from 98.8% (95% CI: 98.3-99.1) to 85.1% (95% CI: 81.9-87.7) in the same period, and for those receiving the last dose at 4-year VE decreased from 99.6% (95% CI: 99.3-99.7) to 79.3% (95% CI: 74.6-83.1). CONCLUSIONS: B. pertussis is circulating in our population, as shown by the epidemic peaks and increased incidence of pertussis in recent years. VE increased with the number of doses and decreased with the follow-up period. The effect of this and other vaccination strategies must be monitored to control the disease.

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INTRODUCTION: The heptavalent pneumococcal conjugate vaccine (PCV-7) was added to the childhood routine vaccination program in the Community of Madrid in November of 2006 with 3+1 recommended doses and a catch-up for those under 2years old. In June 2010, PCV-7 was replaced by 13-valent vaccine (PCV-13) with 2+1 recommended doses. In July of 2012, the PCV-13 was removed from the funded program and reintroduced again (2+1 recommended doses) in December 2014. In between, children were vaccinated privately with 3+1 recommended doses of PCV-13. The aim of this study was to evaluate the effectiveness of each vaccination schedule used in the Community of Madrid. METHODS: We included all cases of invasive pneumococcal disease (IPD) reported between 2007 and 2015 to the Notifiable Diseases Surveillance System. Vaccination information was obtained from the Immunization Registry. Vaccine effectiveness (VE) was estimated using the indirect cohort design for cases with serotype information. RESULTS: A total 779 cases were included in the study. Among them 47.6% of the cases were primo-vaccinated with booster, 20% primo-vaccinated, 15.9% incompletely primo-vaccinated and 16.5% not vaccinated. The VE for ≥1 doses of any PCV was 82% (CI 95%: 67.8-89.9%): 91.9% (CI 95%: 76.5-97.2%) for PCV-7 and 77.2% (48.6-89.9%) for PCV-13. VE in those receiving the full 2+1 or 3+1 schedules was 100% for both vaccines. CONCLUSIONS: A high number of vaccine failures were reported in children before they had the opportunity to receive the booster dose, especially due to PCV-13-non-PCV-7 serotypes. VE was higher for PCV-7 compared to PCV-13, except for those that received the complete schedule with booster that achieved 100% of VE, which shows the relevance of the vaccines and complying with all doses scheduled.

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We describe a community-wide outbreak of measles due to a D4 genotype virus that took place in the Region of Madrid, Spain, between February 2011 and August 2012, along with the control measures adopted. The following variables were collected: date of birth, sex, symptoms, complications, hospital admission, laboratory test results, link with another cases, home address, places of work or study, travel during the incubation period, ethnic group, and Mumps-Measles-Rubella (MMR) vaccination status. Incidences were calculated by 100,000 inhabitants. A total of 789 cases were identified. Of all cases, 36.0% belonged to Roma community, among which 68.7% were 16 months to 19 y old. Non-Roma cases were predominantly patients from 6 to 15 months (28.1%) and 20 to 39 y (52.3%). Most cases were unvaccinated. We found out that 3.0% of cases were healthcare workers. The first vaccination dose was brought forward to 12 months, active recruitment of unvaccinated children from 12 months to 4 y of age was performed and the vaccination of healthcare workers and of members of the Roma community was reinforced. High vaccination coverage must be reached with 2 doses of MMR vaccine, aimed at specific groups, such as young adults, Roma population and healthcare workers.

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Invasive pneumococcal disease (IPD) is a notifiable disease in the Region of Madrid. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for children and adults aged two years or over with a high risk of disease, and for all adults aged 60 and over. We describe the evolution of IPD incidence from 2008 to 2011 in people aged 60 years and over and PPV23 vaccine effectiveness (VE). VE is estimated using both the screening method and indirect cohort method. The incidence of IPD varied from 20.0 in 2008 to 15.2 per 100,000 inhabitants in 2011 (RR: 0.8; 95% CI: 0.6­0.9). Adjusted VE estimated with the screening method was 68.2% (95% CI: 56.2­76.9). VE with the Broome method was 44.5% (95% CI: 23.8­59.6) for all PPV23 serotypes, and 64.4% (95% CI: 45.2­76.8) for PPV23 serotypes not included in conjugate vaccines. VE was lower in patients aged 80 years and older (25.5%; 95% CI:-23.2 to 55.0) and those with highrisk medical conditions (31.7%; 95% CI: -2.2 to -54.4). Adjusted VE was 44.5% (95% CI: 19.4-61.8) within 5 years of vaccination and 32.5% (95% CI: -5.6 to 56.9) after 5 years. These results are compatible with current recommendations for PPV23.

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The objective of this study was to describe the incidence (1982-2005) and epidemiologic characteristics of pertussis cases (1998-2005) in the Autonomous Region of Madrid using data drawn from the epidemiologic surveillance network and computerised hospital discharge data. In the 1990s, the trend in the pertussis incidence in the Autonomous Region of Madrid was clearly falling. The typical seasonal pattern of pertussis remained. A peak in incidence were observed in 2000, and another peak, 2.5 times higher, in 2003. They affected all age groups, but children under one year of age were the most frequent cases, followed by the five to nine year-olds. The greatest increase was seen in the age groups from 10 to 14 and from five to nine. Since 2002, the proportion of cases diagnosed serologically has increased. The incidence of hospital discharges among small children exceeded that of reported cases. More than half of the cases with known vaccination status had received at least three doses of vaccine. The upward trend observed since 2002 could be due to improved case detection, availability of serologic techniques, and a rise in the susceptible population aged five to 14 years. The fact that epidemic peaks continue to occur and that there is a seasonality to the disease seems to indicate that despite the vaccination programme the circulation of the bacteria has not been interrupted. The introduction of the acellular vaccine in 2000 does not appear to have played a significant role in the increase in disease incidence.

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La varicela es la enfermedad primaria causada porel virus varicela-zoster. Es muy contagiosa y frecuenteen niños. En ausencia de vacunación, la mayoríade la población la padece. Objetivo: describir lasituación de la varicela en la Comunidad de Madriddurante los años 2002 a 2005 a través de la Red deMédicos Centinela de la Comunidad de Madrid.Fuente de datos: Red de médicos Centinela de laComunidad de Madrid, que recoge casos de varicelade forma individualizada, desde 2002 a 2005. Se calcularonlas incidencias acumuladas semanales, tasasde incidencia cruda y estandarizada y tasas específicaspor grupos de edad, para cada año, de varicela.Las tasas estandarizadas de incidencia anual devaricela oscilaron entre 587,1 y 1239,6 casos por100000 personas-año, con una notable disminuciónde la incidencia en el año 2005. La mayoría de loscasos se dio en niños. Se observó una periodicidadanual. La forma más frecuente de exposición es elcontacto con otro caso de varicela, y lugar de exposiciónmás común, la guardería o el colegio.En ausencia de vacunación, la incidencia de varicelano ha sufrido cambios significativos en los últimosaños, a excepción del descenso en el año2005. Son necesarios más estudios para determinarla causa de dicho descenso y para evaluar la efectividadde la vacunación contra la varicela. Las redesde médicos centinela son un instrumento válido parala vigilancia de enfermedades como la varicela

Varicella (chickenpox) is the primary disease causedby varicella-zoster virus. It is extremely contagiousand is frequent in children. Indeed, in the absence ofvaccination, most of the population is liable to contractit. The aim of this study is to describe the status for varicellain the Madrid Autonomous Region through theSentinel Practice Network, since 2002 to 2005.Data source: individualised varicella case recordskept by the Madrid Autonomous Region SentinelPractice Network for the period 2002-2005. Cumulativeincidences, crude and standardised incidencerates, and age-specific rates of varicella were calculatedfor each year.Standardised annual varicella incidence rates rangedfrom 587.1 to 1239.6 cases per 100 000 personyears.Most cases affected children. Varicella incidencedisplayed an annual periodicity. The most frequentexposure was the contact with other chickenpoxcases, and the most common place of exposurewas school.In the absence of vaccination, no significant changesin varicella incidence were in evidence recentyears, except the decrease in 2005. Further studiesare needed to assess such decrease and to assessvaccination efficacy. Sentinel practice networks area valid instrument for surveillance of diseases suchas varicella

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The aim of this paper is to compare the seroprevalence of cytomegalovirus (CMV) in women in the Autonomous Region of Madrid (ARM) obtained in two different years (1993 and 1999), according to age and seroprevalence of a virus transmitted by the faecal-oral route (hepatitis A virus, HAV) and another virus of respiratory transmission (varicella zoster virus, VZV). A total of 1813 serum samples were studied, taken from females aged 2-40 in two different serosurveys which were representative of the general population in the ARM. Of these, 933 were taken in 1993, and 880 in 1999. In each survey the samples were distributed over six groups, according to age group (2-5, 6-10, 11-15, 16-20, 21-30 and 31-40 years). CMV- and VZV-specific IgG was tested by indirect ELISA (Dade-Behring, Germany); and HAV-IgG by ImX (Abbott, USA) in the 1993 samples, or by Vidas (BioMérieux, France) in the case of those taken in 1999. A significant age-related rise in CMV seroprevalence was observed in both serosurveys. The seroprevalence obtained was lower in all age groups in 1999 than in 1993. The differences were statistically significant in two age groups: 6-10 years old (43.7 vs. 56.7%) and 31-40 years old (79.1 vs. 90.3%). In the younger age groups concurrent seroprevalence of CMV and VZV was significant lower in 1999. In older age groups a significant decrease in concurrent seroprevalence of both CMV and HAV was also seen. Agreement between serological results for CMV-HAV, CMV-VZV and HAV-VVZ during the two time periods and in every age group was poor or fair (kappa index < or = 0.2 or between 0.21 and 0.4) in all age groups. To conclude, a change in CMV epidemiology seems to be taking place in Madrid. The increase in the proportion of CMV seronegative women of childbearing age may have some impact on the incidence of congenital diseases related to vertical transmission of CMV. Apparently, such a change, among children, could be related to a lower close contact transmission rate (as in VZV), and among adults to improvements in standards of public health (as in HAV). However, due to the poor or fair agreement between serological results for CMV-HAV, CMV-VZV and HAV-VVZ, other independent factors may affect the fall in CMV seroprevalence.

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BACKGROUND: In 1995 the Community of Madrid detected an increase in the number of cases of meningococcal disease caused by serogroup C. In 1997 a mass vaccination campaign was carried out in relation to the population between 18 months and 19 years of age. The purpose of this study is to ascertain the immune response produced by the vaccine and its relationship to the age of the subjects. METHODS: A sample group of 1,003 children vaccinated during the campaign was selected. A blood sample was extracted prior to vaccination and after one, six (only a under 5 years old) and twelve months had transpired. In order to assess the immune response, the levels of bactericidal and total antibodies were measured. RESULTS: The prevalence of seroconversion measured by bactericidal antibodies is 89.6%. The response is low in children under 3 (34.8%), increases with age and, from 7 years on, surpasses the 90% mark. After 6 months, the prevalence of protective levels in children under 5 years of age drops noticeably (31.3%). After one year, the prevalence drops significantly, particularly in children under 7 years of age. The proportion of individuals with total antibody response after one month is over 90%, and remains high after one year in all of the age groups (97.5%). CONCLUSIONS: The response measured by means of total antibodies contradicts the clinical response to the vaccination and the measurement by means of bactericidal antibodies underestimates the protection if it is compared with the results of vaccinal efficacy, for which reason, we need to search for biological indicators that would correlate adequately with the clinical response following immunisation.

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OBJECTIVE: We review the clinical indications and outcomes of surgical procedures in epilepsy which is resistant to medical treatment and the current situation and future possibilities of carrying out surgery for epilepsy in Spain. DEVELOPMENT: Search of the scientific literature included in the data base MEDLINE for the period 1995-1997, retrieval of reports in relation to agencies for the evaluation of health technology of the INAHTA network and the data base of the Cochrane library. The surgery of epilepsy reduces the frequency of seizures (the basic result analyzed) in all groups of patients, although in a very variable manner, depending on the clinical situation and type of operation. The results in patients with temporal lobe epilepsy and in those with localized lesions are particularly good (temporal lobe epilepsy and lesionectomy) (67-69% without seizures), with a follow up period of one to two years. It is estimated that in Spain between 75 and 300 new cases per year would benefit from surgery. The number of patients with drug-resistant epilepsy operated on in Spain is approximately 100-150 patients per year. CONCLUSIONS: Operations for epileptic syndromes, where there are surgically resectable lesions, should be justified by the gravity and impact of the disease on the psychosocial and functional development of the patient. Insufficiency resources are dedicated to the option of surgical treatment and perhaps they are also underused. These operations should be carried out in highly specialized centres, with adequate resources and an annual volume which guarantees excellence.

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BACKGROUND: This report is a systematic review of the effect intensity and duration of the immune response to meningococcal serogroup C vaccine. The vaccine safety, efficacy and effectiveness are also analyzed. METHODS: MEDLINE literature search in the period 1970-1996. Meningoccocal polysaccharide vaccine clinical trials and human prospective studies were specifically searched. Quality of the retrieved studies were analyzed. Information available was integrated. RESULTS: Group C meningoccal polysaccharide vaccine is a safe product. Its efficacy is over 85% among adults and children over 5 years old. 70% (CI 95%: 5-91%) under 5 years old, and 55% among children 2-3 years old. The vaccine is not effective under 2 years. The duration of protective antibody levels decrease with age. The proportion of vaccinated children effectively protected one year after vaccination is low. Vaccination does not affect the immune response to ulterior revaccination. CONCLUSIONS: Group C meningococcal polysaccharide vaccine is indicated in adults and children over 2 years old to protect them from meningococcal disease due to group C when exposed to high risk of infection. The outbreaks control is the main indication for the use of this vaccine. Routine immunization in not outbreak situation is not recommended due to the small vaccine protection in children under 2 years old, the limited efficacy in children under 5, and the short duration of the immunity in children.

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