#Enterovirus A71 #Infection and #Neurologic Disease, Madrid, #Spain, 2016 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 1—January 2019 / CME ACTIVITY – Synopsis

Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016

Carmen Niño Taravilla1  , Isabel Pérez-Sebastián1, Alberto García Salido, Claudia Varela Serrano, Verónica Cantarín Extremera, Anna Duat Rodríguez, Laura López Marín, Mercedes Alonso Sanz, Olga María Suárez Traba, and Ana Serrano González

Author affiliations: Hospital Infantil Universitario Niño Jesús, Madrid, Spain



We conducted an observational study from January 2016 through January 2017 of patients admitted to a reference pediatric hospital in Madrid, Spain, for neurologic symptoms and enterovirus infection. Among the 30 patients, the most common signs and symptoms were fever, lethargy, myoclonic jerks, and ataxia. Real-time PCR detected enterovirus in the cerebrospinal fluid of 8 patients, nasopharyngeal aspirate in 17, and anal swab samples of 5. The enterovirus was genotyped for 25 of 30 patients; enterovirus A71 was the most common serotype (21/25) and the only serotype detected in patients with brainstem encephalitis or encephalomyelitis. Treatment was intravenous immunoglobulins for 21 patients and corticosteroids for 17. Admission to the pediatric intensive care unit was required for 14 patients. All patients survived. At admission, among patients with the most severe disease, leukocytes were elevated. For children with brainstem encephalitis or encephalomyelitis, clinicians should look for enterovirus and not limit testing to cerebrospinal fluid.

Keywords: EV-A71; Encephalitis; Spain.



#Surveillance of #enteroviruses from #paediatric patients attended at a tertiary #hospital in #Catalonia from 2014 to 2017 (J Clin Virol., abstract)

[Source: Science Direct, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 30 November 2018 / In Press, Accepted Manuscript

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

Cristina Andrés a, Jorgina Vila b, Laura Gimferrer a , Maria Piñana a, Juliana Esperalba a, Maria Gema Codina a, Meritxell Barnés b, Mariadel Carmen Martín a, Francisco Fuentes a, Susana Rubio a, Pilar Alcubilla a, Carlos Rodrigo b, Tomàs Pumarola a, Andrés Antón a

{a} Respiratory Viruses Unit, Virology Section, Microbiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; {b} Paediatric Hospitalisation Unit, Department of Paediatrics, Hospital Universitari Maternoinfantil Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

Received 4 September 2018, Revised 26 October 2018, Accepted 16 November 2018, Available online 30 November 2018.

DOI: https://doi.org/10.1016/j.jcv.2018.11.004



  • The study reports virological and clinical enterovirus surveillance in Catalonia.
  • The four enterovirus species cocirculated, distinguishing up to 27 different types.
  • Most of neurological studied cases were from the 2016 spring outbreak.
  • EV-A71 was one of the most detected EV, mostly during the outbreak.
  • Rhombencephalitis cases were related to EV-A71 infection.
  • EV-D68 was associated with lower respiratory tract infections.
  • Necessity to perform EV surveillance in primary care settings.




Enterovirus (EV) infections are usually asymptomatic or mild, but symptomatic infections can evolve to severe complications. Outbreaks of EV-A71 and EV-D68 have been recently reported worldwide, sometimes related to severe clinical outcomes.


To describe EV genetic diversity and the clinical outcomes from paediatric patients attended at a tertiary university hospital in Barcelona (Catalonia, Spain) from 2014 to 2017.

Study design

Specimens were collected from paediatric (<17 years old) cases with suspicion of respiratory tract infection or EV infection. EV laboratory-confirmation was performed by specific real-time multiplex RT-PCR assay. Partial viral VP1 protein was sequenced for genetic characterisation by phylogenetic analyses.


A total of 376 (7%) from 5,703 cases were EV laboratory-confirmed. Phylogenetic analyses of VP1 (210; 81%) sequences distinguished up to 27 different EV types distributed within EV-A (82; 40%), EV-B (90; 42%), EV-C (5; 2%), and EV-D (33; 15%), in addition to 50 (19%) rhinoviruses. The most predominant were EV-A71 (37; 45%) and EV-D68 (32; 99%). EV-A71 was highly related to neurological complications (25/39, 63%), of which 20/39 were rhombencephalitis, and most EV-D68 (28/32, 88%) were associated with lower respiratory tract infections (LRTI), and exceptionally one (3%) with flaccid paralysis.


EV-A71 and EV-D68 were the most detected EV in respiratory specimens. EV-A71 was highly related to neurological disease and EV-D68 was often associated with LRTI. However, both potential relatedness to neurological diseases makes the monitoring of EV circulation obligatory.

Keywords: enteroviruses – respiratory infections – surveillance – genetic diversity – molecular epidemiology – paediatric population

© 2018 Elsevier B.V. All rights reserved.

Keywords: Enterovirus; EV-A71; EV-D68; Rhomboencephalitis; AFP; Spain.


#Varicella-zoster Virus #Clades Circulating in #Spain over two decades (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 28 November 2018 / In Press, Accepted Manuscript

Varicella-zoster Virus Clades Circulating in Spain over two decades

Irene González 1, Alejandro Molina 1, Pilar Pérez-Romero, Juan Emilio Echevarría, Lante He, David Tarragó

Centro Nacional de Microbiología (CNM), Instituto de Salud Carlos III, Majadahonda, Spain

Received 5 June 2018, Revised 30 August 2018, Accepted 26 November 2018, Available online 28 November 2018.

DOI: https://doi.org/10.1016/j.jcv.2018.11.008



  • In this first Spanish molecular epidemiological study, encephalitis was more frequent in patients infected with VZV clades within genogroup E, suggesting earlier introduction of these clades.
  • First evidence of recombination in Spain: VZV clade 1 and clade 3 recombinants were found in six cases.
  • VZV clade 2 vaccine strains were found in three patients with herpes zoster and one with neurological disease (encephalitis and retinitis).




Despite childhood universal VZV immunization was introduced in 2015, there are no data on VZV clade distribution in Spain.


To characterize the varicella-zoster virus strains circulating in Spain between 1997 and 2016.

Study Design

In this retrospective study, we determined the VZV clades in 294 patients with different pathologies (mainly encephalitis, zoster and varicella) by sequencing three fragments within ORF 22, ORF 21 and ORF 50 and, subsequently analyzing 7 relevant SNPs.


Among these 294 patients, 132(44.9%) patients were infected by clade 1, 42(14.3%) patients by clade 3, 19(6.5%) by clade 5, 29(9.9%) by clade VI and 3(1%) by clade 4. Four patients (1.4%) were infected by clade 2 vOKA strains, who received one dose of live-attenuated varicella vaccine. Putative recombinant clade 1/3 was identified in 6 cases (2.0%). Results obtained from partial sequences were assigned to clade 1 or 3 in 56(19%) patients and clade 5 or VI in 3(1.0%) patients. In the multivariate analysis, encephalitis was independently associated with clades 1 and 3 and age >14y.o. (P = 0.035 and P = 0.021, respectively). Additionally, Madrid had significant fewer cases of encephalitis compared with the rest of regions analyzed (P = 0.001).


Higher prevalence of clades 1 and 3 and their relation with encephalitis and age >14y.o. suggest earlier introduction of this clades in Spain. Putative interclade 1 and 3 recombinants are circulating in patients with encephalitis, herpes zoster and varicella. Several cases were related to vOKA vaccination but vaccine strains do not seem to circulate in the general population.

Abbreviations: VZV: Varicella-zoster virus – CSF: Cerebral Spinal Fluid – ORF: Open reading frame – vOKA: vaccine-OKA – bp: base pair – y.o.: years old – SNPs: Single Nucleotide Polymorphisms

Keywords: Varicella zoster virus – Recombination – Clade – Genotype – Vaccine – Molecular epidemiology

{1} These authors contributed equally to this study.

© 2018 Elsevier B.V. All rights reserved.

Keywords: Varicella; Encephalitis; Spain; VZV.


#Influenza #vaccine #effectiveness in reducing severe #outcomes over six influenza seasons, a case-case analysis, #Spain, 2010/11 to 2015/16 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Influenza vaccine effectiveness in reducing severe outcomes over six influenza seasons, a case-case analysis, Spain, 2010/11 to 2015/16

Pere Godoy1,2,3, Arantxa Romero2, Núria Soldevila2,4, Nuria Torner1,2,4, Mireia Jané1,2, Ana Martínez1,2, Joan A Caylà5, Cristina Rius2,6,Angela Domínguez2,4, The Working Group on Surveillance of Severe Influenza Hospitalized Cases in Catalonia7

Affiliations: 1 Agència de Salut Pública de Catalunya, Barcelona, Spain; 2 CIBER Epidemiología y Salud Pública, Barcelona, Spain; 3 IRBLleida. Institut de Recerca Biomèdica de Lleida, Lleida, Spain; 4 Universitat de Barcelona, Barcelona, Spain; 5 TB Research Unit Foundation (fuiTB), Barcelona, Spain; 6 Agència de Salut Pública de Barcelona, Barcelona, Spain; 7 The Working Group on Surveillance of Severe Influenza Hospitalized Cases in Catalonia have been listed at the end of this article

Correspondence:  Pere Godoy

Citation style for this article: Godoy Pere, Romero Arantxa, Soldevila Núria, Torner Nuria, Jané Mireia, Martínez Ana, Caylà Joan A, Rius Cristina, Domínguez Angela,The Working Group on Surveillance of Severe Influenza Hospitalized Cases in Catalonia. Influenza vaccine effectiveness in reducing severe outcomes over six influenza seasons, a case-case analysis, Spain, 2010/11 to 2015/16. Euro Surveill. 2018;23(43):pii=1700732. https://doi.org/10.2807/1560-7917.ES.2018.23.43.1700732

Received: 30 Oct 2017;   Accepted: 06 Apr 2018




When influenza vaccination is ineffective in preventing influenza virus infection, it may still reduce the severity of influenza-associated disease. Here, we estimate the effect of influenza vaccination in preventing severe outcomes e.g. intensive care unit (ICU) admission and death, even though it did not prevent influenza virus infection and subsequent hospitalisation.


An observational case–case epidemiological study was carried out in 12 sentinel hospitals in Catalonia (Spain) over six influenza seasons 2010/11–2015/16. Cases were individuals with severe laboratory-confirmed influenza virus infection and aged 18 years and older. For each reported case we collected demographic, virological and clinical characteristics. Logistic regression was used to estimate the crude, adjusted odd ratios (aOR) and 95% confidence intervals (CI).


Of 1,727 hospitalised patients included in the study, 799 were female (46.7%), 591 (34.2%) were admitted to the ICU and 223 (12.9%) died. Influenza vaccination uptake was lower in cases that required ICU admission or died (21.2% vs 29.7%, p < 0.001). The adjusted influenza vaccination effectiveness in preventing ICU admission or death was 23% (95% CI: 1 to 40). In an analysis restricted to sex, age group and antiviral treatment, influenza vaccination had a positive effect on disease severity in all age groups and categories.


We found that influenza vaccination reduced the severity of disease even in cases where it did not prevent infection and influenza-associated hospitalisation. Therefore, increased vaccination uptake may reduce complications, ICU admission and death.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Seasonal Influenza; SARI; Vaccines; Spain.


Age-specific Excess #Mortality #Patterns During the 1918-1920 #Influenza #Pandemic in Madrid, #Spain (Am J Epidemiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Epidemiol. 2018 Aug 14. doi: 10.1093/aje/kwy171. [Epub ahead of print]

Age-specific Excess Mortality Patterns During the 1918-1920 Influenza Pandemic in Madrid, Spain.

Cilek L1, Chowell G2,3, Fariñas DR1.

Author information: 1 Institute of Economy, Geography and Demography (IEGD), Center for Humanities and Social Sciences (CCHS) Spanish National Research Council, Madrid, Spain. 2 School of Public Health, Division of Epidemiology & Biostatistics, Georgia State University, Atlanta, Georgia. 3 Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.



Although much progress has been made to uncover age-specific mortality patterns of the 1918 influenza pandemic in populations around the world, more studies in different populations are needed to make sense of the heterogeneous mortality impact of this deadly pandemic. Here we assess the absolute and relative magnitude of 3 pandemic waves in city of Madrid between 1918-1920 based on age-specific all-cause and respiratory excess death rates. We estimate excess death rates using a Serfling model with a parametric bootstrapping approach to calibrate baseline mortality levels with quantified uncertainty. We then estimate excess all-cause and pneumonia and influenza mortality rates for different pandemic waves and age groups. Age-specific analyses reveal the youngest and oldest experienced the highest excess mortality rates, and young adults faced the highest standardized mortality risk. Waves differed in strength; the peak standardized mortality risk occurred during the herald wave in spring 1918, but the highest excess rates occurred during the fall and winter of 1918-1919. We find little evidence to support a ‘w’-shaped age-specific excess mortality curve. Our results indicate acquired immunity may have tempered a protracted fall wave, but recrudescent waves following the initial two outbreaks heightened the total pandemic mortality impact.

PMID: 30124746 DOI: 10.1093/aje/kwy171

Keywords: Pandemic Influenza; H1N1; Spanish Flu; Spain.


#Human #Pasteurella multocida #Infection with Likely #Zoonotic Transmission from a Pet #Dog, #Spain (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 6—June 2018 / Research Letter

Human Pasteurella multocida Infection with Likely Zoonotic Transmission from a Pet Dog, Spain

Fátima Abreu, Carlos Rodríguez-Lucas, M. Rosario Rodicio, Ana I. Vela, José Francisco Fernández-Garayzábal, Pilar S. Leiva, Fernando Cuesta, Dolores Cid, and Javier Fernández

Author affiliations: Principado de Asturias Sanitary Research Institute, Oviedo, Spain (F. Abreu, C. Rodriguez-Lucas, M.R. Rodicio, P.S. Leiva, J. Fernández); Central Universitary Hospital, Asturias, Spain (F. Abreu, C. Rodriguez-Lucas, P.S. Leiva, J. Fernández); University of Oviedo, Asturias (C. Rodriguez-Lucas, M.R. Rodicio); Complutense University, Madrid, Spain (A.I. Vela, J.F. Fernández-Garayzábal, D. Cid); Principado de Asturias Health Care System, Pola de Siero Primary Care Center, Pola de Siero, Spain (F. Cuesta)



We report a case of urinary tract infection caused by an unusual genotype (sequence type 211) of Pasteurella multocida associated with human infection. Molecular genetic analysis of P. multocida isolates obtained from the human patient and his pet strongly suggests a zoonotic transmission of this bacterium.

Keywords: Pasteurella multocida; Human; Dogs; Spain.


#Antibodies against 1940s era a/ #H1N1 #influenza strains a/Weiss/43 and a/FM/1/47 and heterotypic responses after seasonal #vaccination of an elderly Spanish population (Immun Ageing, abstract)

[Source: Immunity and Ageing, full page: (LINK). Abstract, edited.]

Research / Open Access

Antibodies against 1940s era a/H1N1 influenza strains a/Weiss/43 and a/FM/1/47 and heterotypic responses after seasonal vaccination of an elderly Spanish population

Ivan Sanz, Silvia Rojo, Sonia Tamames, Jose María Eiros and Raúl Ortiz de Lejarazu

Immunity & Ageing, 201815:9 / DOI: https://doi.org/10.1186/s12979-018-0116-9

©  The Author(s). 2018

Received: 3 November 2017 – Accepted: 19 February 2018 – Published: 27 February 2018



Background and methods

Elderly people have experienced several influenza natural infections and seasonal vaccinations during their lives. The aim of this work was to evaluate in an elderly Spanish population the presence of antibodies (Abs) against some 1940s era A/H1N1 influenza viruses and some new influenza viruses. We also evaluated the homologous and heterotypic responses after seasonal influenza vaccination. We collected pre- and post-vaccination serum samples from 174 elderly people (≥65 years) who were vaccinated with seasonal influenza vaccines during the 2006–2007, 2008–2009, 2009–2010, and 2010–2011 northern hemisphere influenza campaigns. The presence of Abs against the 1940s era A/Weiss/43 and A/FM/1/47 strains of the A/H1N1 influenza virus was evaluated by using hemagglutination inhibition assays.


Pre-vaccination Abs against the A/Weiss/43 and A/FM/1/47 strains were present at protective titres (≥1/40) in 43.7% and 20.1% of the study population respectively. Seasonal influenza vaccination induced heterotypic seroconversion against A/Weiss/43 in 16.1% of the individuals and against A/FM/1/47 in 13.2% of the individuals. The seroprotection rate for the study population after seasonal vaccination was 63.2% against A/Weiss/43 and 31.0% against A/FM/1/47. The heterotypic response did not satisfy the European Medicament Agency criteria for people aged ≥60 years.


A moderate percentage of elderly people had Abs against the 1940s era A/Weiss/43 and A/FM/1/47 strains of the A/H1N1 influenza subtype. Seasonal influenza vaccination induced a low but significant heterotypic response against both 1940s era influenza strains, reaching a high seroprotection rate for the A/Weiss/43 strain. Seasonal influenza vaccination can increase, within certain limitations, the Abs titres against old influenza strains not included in the composition of the vaccine itself.

Keywords: Influenza A; H1N1; Vaccines; Spain.