1
|
Pampaka D, López-Perea N, Fernández-García A, Huertas-Zarco I, Castellanos-Martínez M, Villatoro-Bongiorno K, Roig-Sena J, Torner N, Mar Mosquera M, Echevarría JE, Prats JF, Masa-Calles J. An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018. Euro Surveill 2023; 28. [PMID: 37103785 DOI: 10.2807/1560-7917.es.2023.28.17.2200634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Given sustained high vaccination coverage and enhanced surveillance for measles, Spain has been free of endemic measles transmission since 2014, achieving elimination certification from the World Health Organization in 2017. In November 2017, measles was introduced through an imported case travelling to the Valencian Community, causing an interregional outbreak. Here, we describe the outbreak using data reported to the national epidemiological surveillance network. The outbreak involved 154 cases (67 males, 87 females) notified in four regions; 148 were laboratory-confirmed and six epidemiologically linked. Most cases were adults aged 30-39 (n = 62, 40.3%) years. Sixty-two cases were hospitalised (40.3%) and 35 presented complications (22.7%). Two thirds of the cases (n = 102) were unvaccinated including 11 infants (≤ 1 year) not yet eligible for vaccination. The main route of transmission was nosocomial; at least six healthcare facilities and 41 healthcare workers and support personnel were affected. Sequencing of the viral nucleoprotein C-terminus (N450) identified genotype B3, belonging to the circulating MVs/Dublin.IRL/8.16-variant. Control measures were implemented, and the outbreak was contained in July 2018. The outbreak highlighted that raising awareness about measles and improving the vaccination coverage in under-vaccinated subgroups and personnel of healthcare facilities are key measures for prevention of future outbreaks.
Collapse
Affiliation(s)
- Despina Pampaka
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Huertas-Zarco
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Maite Castellanos-Martínez
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Katja Villatoro-Bongiorno
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Javier Roig-Sena
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Valencia, Spain
| | - Nuria Torner
- Universitat de Barcelona, Barcelona, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - María Mar Mosquera
- Microbiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Juan Emilio Echevarría
- National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Josefa Masa-Calles
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
2
|
Santos Bravo M, Plault N, Sánchez-Palomino S, Rodríguez C, Navarro Gabriel M, Mosquera MM, Fernández Avilés F, Suarez-Lledó M, Rovira M, Bodro M, Moreno A, Linares L, Cofan F, Berengua C, Esteva C, Cordero E, Martin-Davila P, Aranzamendi M, Pérez Jiménez AB, Vidal E, Fernández Sabé N, Len O, Hantz S, Alain S, Marcos MÁ. Genotypic and phenotypic study of antiviral resistance mutations in refractory cytomegalovirus infection. J Infect Dis 2022; 226:1528-1536. [PMID: 35993155 DOI: 10.1093/infdis/jiac349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
This study describes the genotypic and phenotypic characterisation of novel human cytomegalovirus (HCMV) genetic variants of a cohort of 94 clinically-resistant HCMV patients. Antiviral-resistant mutations were detected in the UL97, UL54 and UL56 target genes of 25/94 (26.6%) patients. The genotype-phenotype correlation study resolved the status of 5 uncharacterised UL54 DNA polymerase (G441S, A543V, F460S, R512C, A928T) and 2 UL56 terminase (F345L, P800L) mutations found in clinical isolates. A928T conferred high triple-resistance to ganciclovir, foscarnet and cidofovir, and A543V had 10-fold reduced susceptibility to cidofovir. Viral growth assays showed G441S, A543V, F345L and P800L impaired viral growth capacities compared with wild-type AD169 HCMV. 3D modelling predicted A543V and A928T phenotypes but not R512C, reinforcing the need for individual characterisation of mutations by recombinant phenotyping. Extending mutation databases is crucial to optimize treatments and to improve the assessment of patients with resistant/refractory HCMV infection.
Collapse
Affiliation(s)
- Marta Santos Bravo
- Microbiology Department, Hospital Clinic of Barcelona, University of Barcelona. Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Nicolas Plault
- National Reference Center for Herpesviruses, Microbiology Department, CHU Limoges, Limoges, France.,UMR Inserm 1092, University of Limoges, Limoges, France
| | - Sonsoles Sánchez-Palomino
- AIDS Research Group, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic I Provincial de Barcelona, University of Barcelona, Barcelona, Spain
| | - Cristina Rodríguez
- Microbiology Department, Hospital Clinic of Barcelona, University of Barcelona. Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Mireia Navarro Gabriel
- Microbiology Department, Hospital Clinic of Barcelona, University of Barcelona. Institute for Global Health (ISGlobal), Barcelona, Spain
| | - María Mar Mosquera
- Microbiology Department, Hospital Clinic of Barcelona, University of Barcelona. Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Francesc Fernández Avilés
- Bone Marrow Transplant Unit, Hematology Department, Clinical Institute of Hematological and Oncological Diseases (ICMHO) Hospital Clinic of Barcelona, , Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - María Suarez-Lledó
- Bone Marrow Transplant Unit, Hematology Department, Clinical Institute of Hematological and Oncological Diseases (ICMHO) Hospital Clinic of Barcelona, , Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Montserrat Rovira
- Bone Marrow Transplant Unit, Hematology Department, Clinical Institute of Hematological and Oncological Diseases (ICMHO) Hospital Clinic of Barcelona, , Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Diseases Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laura Linares
- Infectious Diseases Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Frederic Cofan
- Renal Transplantation Unit, Department of Nephrology. Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carla Berengua
- Microbiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Esteva
- Molecular Microbiology Unit, Hospital Universitari Sant Joan de Déu, Barcelona, Spain. Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Universitat de Barcelona. Centre of Biomedical Research for Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine. Viral and Infectious Diseases in Immunodeficient Group. Institute of Biomedicine of Seville (IBiS). Virgen del Rocio University Hospital. University of Seville. Seville, Spain
| | | | - Maitane Aranzamendi
- Microbiology Department. Hospital Universitario de Cruces, Donostia, Gipuzkoa, Spain
| | - Ana Belén Pérez Jiménez
- Microbiology Unit, Hospital Universitario Reina Sofía, Intituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Intitute of Carlos III, Madrid, Spain
| | - Elisa Vidal
- Microbiology Unit, Hospital Universitario Reina Sofía, Intituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain. Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Intitute of Carlos III, Madrid, Spain
| | - Nuria Fernández Sabé
- Department of Infectious Diseases, Bellvitge University Hospital, Insitut D'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Oscar Len
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sebastien Hantz
- National Reference Center for Herpesviruses, Microbiology Department, CHU Limoges, Limoges, France.,UMR Inserm 1092, University of Limoges, Limoges, France
| | - Sophie Alain
- National Reference Center for Herpesviruses, Microbiology Department, CHU Limoges, Limoges, France.,UMR Inserm 1092, University of Limoges, Limoges, France
| | - María Ángeles Marcos
- Microbiology Department, Hospital Clinic of Barcelona, University of Barcelona. Institute for Global Health (ISGlobal), Barcelona, Spain
| | | |
Collapse
|
3
|
Martínez MJ, Basile L, Sisó-Almirall A, Cristino V, Cuesta G, Hurtado JC, Fernandez-Pittol M, Mosquera MM, Soriano A, Martínez A, Marcos MA, Vila J, Casals-Pascual C. Lack of Prognostic Value of SARS-CoV2 RT-PCR Cycle Threshold in the Community. Infect Dis Ther 2021; 11:587-593. [PMID: 34762246 PMCID: PMC8582337 DOI: 10.1007/s40121-021-00561-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
The immense impact of the COVID-19 pandemic on health systems has motivated the scientific community to search for clinical prognostic factors for SARS-CoV-2 infection. Low cycle threshold values (Ct) of diagnostic real-time RT-PCR assays in hospitalized patients have been associated with a poor prognosis in several studies, whereas other studies did not find this association. We explored whether SARS-CoV-2 Ct values at diagnosis were associated with a poor outcome (admission to hospital and death) in 604 community patients diagnosed at primary health centers. Although lower Ct values were found in patients who died of COVID-19, the Ct value was not significantly associated with a worse outcome in a multivariate analysis, while age remained an independent prognostic factor. We did not find evidence to support the role of Ct values as a prognostic factor of COVID-19 in community cases.
Collapse
Affiliation(s)
- Miguel J Martínez
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Luca Basile
- Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Victor Cristino
- Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Genoveva Cuesta
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - María Mar Mosquera
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana Martínez
- Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
| | - Mª Angeles Marcos
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Jordi Vila
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Climent Casals-Pascual
- Department of Microbiology, CDB, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
| |
Collapse
|
4
|
Nicolás D, Suárez A, Ambrosioni J, Manzardo C, Ligero C, Costa J, Fernández E, Marcos MÁ, Plana M, Mosquera MM, Sánchez-Palomino S, Gatell JM, Miró JM. Prevalence, clinical characteristics and outcome of severe primary HIV-1 infection: A prospective cohort study. Int J Infect Dis 2019; 88:73-79. [PMID: 31401201 DOI: 10.1016/j.ijid.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe cases of primary HIV infection have been described in patients presenting with neurological involvement, AIDS defining events or other life-threatening events. These severe forms have not been fully studied. OBJECTIVES To determine the prevalence and characteristics of severe PHI in a hospital-based cohort of primary HIV infection, and the response to the early initiation of antiretroviral therapy (ART) at 12 months. METHODS Every patient with PHI attending Hospital Clínic of Barcelona (1997-2015) was evaluated. Severe PHI was defined using clinical, analytical and immunological criteria. Chi-squared test was used for categorical variables and Student's t-test for quantitative variables. RESULTS 33% of 224 PHI patients (95% CI: 26.84%-39.16%) had a severe PHI. These patients had more symptoms, abnormal analytical parameters and hospital admissions. The severe PHI group had a significantly higher viral load although no differences were observed at 12 months in terms of viral suppression or CD4 count recovery. None died during PHI. CONCLUSIONS Up to one third of patients in our cohort presented with a severe PHI, which was associated with higher hospitalization rates and higher plasma HIV RNA viral load. However, severe forms were not associated to a worse clinical, immunological or virological outcome at 12 months.
Collapse
Affiliation(s)
- David Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Antoni Suárez
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Carmen Ligero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Josep Costa
- Microbiology Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Emma Fernández
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - M Ángeles Marcos
- Microbiology Service, Hospital Clinic, University of Barcelona, Institute for Global Health, (ISGlobal), Barcelona, Spain.
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Spain.
| | - María Mar Mosquera
- Microbiology Service, Hospital Clinic, University of Barcelona, Institute for Global Health, (ISGlobal), Barcelona, Spain.
| | - Sonsoles Sánchez-Palomino
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Spain.
| | - Jose M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
5
|
Nicolás D, Ambrosioni J, de Lazzari E, Suarez A, Manzardo C, Agüero F, Mosquera MM, Costa J, Ligero C, Marcos MÁ, Sánchez-Palomino S, Fernández E, Plana M, Yerly S, Gatell JM, Miró JM. Epidemiological changes of acute/recent human immunodeficiency virus type 1 infection in Barcelona, Spain (1997-2015): a prospective cohort study. Clin Microbiol Infect 2018; 25:878-884. [PMID: 30472421 DOI: 10.1016/j.cmi.2018.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the epidemiology of acute/recent human immunodeficiency virus (HIV) infection over two decades in Barcelona (Spain). METHODS Prospective, single-centre cohort including all patients with an acute/recent HIV infection (<180 days) since 1997. Patients were stratified into four periods. Phylogenetic analysis was performed to determine clusters of transmission. RESULTS A total of 346 consecutive acute/recently infected patients were included. The annual proportion of recent infections among total new HIV diagnoses increased over time from 1% (29 out of 1964) to 8% (112 out of 1474) (p <0.001). Proportion of men who have sex with men (MSM) in the cohort increased from 62% (18 out of 29) to 89% (100 out of 112) (p <0.001). The proportion of migrants showed a non-significant increasing trend (24% (7 of 29) to 40% (45 of 112)) likewise the non-B subtype (0% to 22% (22 of 112)). The mean time from infection to diagnosis was 53.6 days (interquartile range (IQR) 50-57), comparable among all periods. Mean time from infection to treatment decreased over the years from 575 (IQR 467-683) to 471 (IQR 394-549) days (p <0.001) without significant differences between migrants and non-migrants (133 (IQR 71-411) versus 208 (IQR 90-523) days p 0.089). Almost 50% (152 of 311) of recently infected individuals were included in a cluster of transmission, and 92% (137 of 149) of them were MSM. CONCLUSION The MSM population has progressively grown within acutely/recently infected patients in Barcelona, and is frequently involved in transmission clusters. Although the time between diagnosis and treatment has been reduced, the time between infection and diagnosis still needs to be shortened.
Collapse
Affiliation(s)
- D Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E de Lazzari
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A Suarez
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F Agüero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M M Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - J Costa
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - C Ligero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Á Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic Barcelona, CIBERehd, University of Barcelona, Barcelona, Spain
| | - S Sánchez-Palomino
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - E Fernández
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - S Yerly
- Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
| | | |
Collapse
|
6
|
Gil H, Fernández-García A, Mosquera MM, Hübschen JM, Castellanos AM, de Ory F, Masa-Calles J, Echevarría JE. Measles virus genotype D4 strains with non-standard length M-F non-coding region circulated during the major outbreaks of 2011-2012 in Spain. PLoS One 2018; 13:e0199975. [PMID: 30011283 PMCID: PMC6047782 DOI: 10.1371/journal.pone.0199975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
In recent decades, vaccination has substantially reduced the number of measles cases to levels close to the elimination stage. However, major measles outbreaks occurred in Europe during 2010-2012, after the introduction of the D4-Enfield lineage. We have performed a molecular characterization of 75 measles virus genotype D4 strains from patients infected in Spain between 2004 and 2012 by sequencing the N-450 region and the M-F non-coding region (M-F NCR) in order to identify genetic features of these viruses. The analysis of the N-450 region confirmed that all samples obtained since 2008 belonged to variants or sets of identical sequences of the D4-Enfield lineage, including a new one named MVs/Madrid.ESP/46.10/. Analysis of the M-F NCR showed insertions and deletions associated with previously described, uncommon non-standard genome length measles viruses. This genetic feature was identified in the D4-Enfield lineage viruses, but not in the other D4 viruses that were circulating in Spain before 2008, suggesting that these non-standard length M-F NCR sequences are characteristic of the D4-Enfield lineage. The results of the phylogenetic analysis of Spanish M-F NCRs suggest higher resolution in discriminating strains than did the N-450 analysis. In addition, the results of the analysis of the M-F NCR on the MVs/Madrid.ESP/46.10/ sub-lineage seem to support the potential utility of this region as a tool for epidemiological surveillance complementary to the N-450 region, as previously suggested. Further investigation on this question, as well as the surveillance of new potentially emerging strains with non-standard length M-F NCR are strongly recommended as part of future strategies for measles elimination.
Collapse
Affiliation(s)
- Horacio Gil
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Aurora Fernández-García
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - María Mar Mosquera
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Judith M. Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Ana M. Castellanos
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fernando de Ory
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan E. Echevarría
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
7
|
Nicolás D, Ambrosioni J, Sued O, Brunet M, López-Diéguez M, Manzardo C, Agüero F, Tuset M, Plana M, Guardo AC, Mosquera MM, Muñoz-Fernández MÁ, Caballero M, Marcos MÁ, Gatell JM, de Lazzari E, Gallart T, Miró JM. Cyclosporine A in addition to standard ART during primary HIV-1 infection: pilot randomized clinical trial. J Antimicrob Chemother 2017; 72:829-836. [PMID: 27999018 DOI: 10.1093/jac/dkw462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/02/2016] [Indexed: 11/12/2022] Open
Abstract
Background Initiating ART during acute/recent HIV-1 infection reduces viral reservoir formation. It has been proposed that, during this phase, the size of the viral reservoir could be further reduced by the association of immunomodulatory therapy with ART. Contradictory results have emerged, however, from two trials evaluating the impact on immune recovery and the viral reservoir of adding cyclosporine A to ART during primary HIV-1 infection. Patients and methods Twenty patients with acute/recent HIV-1 infection were randomized to receive ART alone (tenofovir, emtricitabine and lopinavir/ritonavir) or associated with 8 weeks of cyclosporine A (0.3-0.6 mg/kg twice daily). The impact on viral load, immune response and integrated and non-integrated DNA viral reservoir at 0, 8 and 36 weeks of treatment was evaluated. Results The estimated median time from HIV-1 infection to ART onset was 63 days (IQR 53; 79.5) with 90% of patients at Fiebig V stage. No significant differences were observed in viral load decay, CD4 T cell recovery, immune response markers or the evolution of integrated DNA at week 8 (end of cyclosporine A) and week 36 between groups. However, non-integrated DNA significantly increased in the cyclosporine A arm between weeks 0 and 36. Cyclosporine A was well tolerated. Conclusions Adding cyclosporine A to ART during acute/recent infection did not improve immune recovery. However, unintegrated DNA increased in the cyclosporine A group, suggesting an anti-integration effect, a point warranting further research (ClinicalTrials.gov Identifier: NCT00979706).
Collapse
Affiliation(s)
- David Nicolás
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Omar Sued
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mercé Brunet
- Pharmacology and Toxicology Department, Biomedical Diagnostic Center, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - María López-Diéguez
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Fernando Agüero
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Montserrat Tuset
- Pharmacy Department, Hospital Clinic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alberto C Guardo
- Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - María Mar Mosquera
- Department of Clinical Microbiology, Hospital Clínic, Barcelona, Spain/ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - M Ángeles Muñoz-Fernández
- Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Spanish HIV-HGM Biobank, Networking Research Center on Bioengineering, Biomaterials & Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Miguel Caballero
- Otorhinolaryngology Department, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Ángeles Marcos
- Department of Clinical Microbiology, Hospital Clínic, Barcelona, Spain/ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - José M Gatell
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Elisa de Lazzari
- Fundació Clinic per a la Recerca Biomèdica, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Teresa Gallart
- Immunology Department, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
Ambrosioni J, Artigues F, Nicolás D, Peñafiel J, Agüero F, Manzardo C, Mar Mosquera M, Sánchez-Palomino S, De Lazzari E, Marcos MA, Plana M, Miró JM. Neurological involvement in patients with acute/recent HIV-1 infection. A case-control study. J Neurovirol 2017; 23:679-685. [PMID: 28718069 DOI: 10.1007/s13365-017-0548-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/13/2017] [Indexed: 01/30/2023]
Abstract
Primary HIV-1 infection is a relevant period for its virological and epidemiological consequences. Most patients present a symptomatic disease that can be potentially serious, but neurological involvement during primary HIV-1 infection has been poorly studied. The aim of this study was to describe the characteristics and outcomes of primary HIV-1 infection patients presenting neurological symptoms and to compare them with primary HIV-1 infection patients without neurological involvement. Retrospective case-control study (1:3) comparing primary HIV-1 infection patients with and without neurological involvement enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016. Matching criteria included age (±10 years), gender, year of diagnosis (±4 years), and Fiebig stage. The conditional logit model was used for comparisons. Fourteen out of 463 patients (3.02%) enrolled in the Acute/Recent Hospital Clinic PHI Cohort between 1997 and 2016 presented neurological symptoms. 28.5% of cases presented as meningitis and 71.5% as meningoencephalitis. Cerebrospinal fluid showed non-specific findings, including pleocytosis with lymphocyte predominance and increased protein levels. All cases required hospitalisation, whereas only 19% of the controls did. No other pathogen was identified in any case, but five patients initiated empirically antimicrobial treatment for other aetiologies until diagnosis was confirmed. CD4/CD8 ratio was significantly lower (p = 0.039) and plasmatic viral load significantly higher in the case group, compared to controls (p = 0.028). Risk factors, HIV-1 tropism, subtype distribution, and prescribed ART regimens were comparable between cases and controls. After 6 months on ART, 92% of cases had undetectable viral load, similar to controls, and CD4/CD8 ratio became also comparable between groups. All cases recovered rapidly with ART and were discharged without sequels. Neurological involvement during primary HIV-1 infection is unusual but serious, always requiring hospitalisation. Diagnosis is difficult because of the wide range of symptoms and similarities with other viral aetiologies. Neurological manifestations during primary HIV-1 infection are associated with a lower CD4/CD8 ratio and with a higher viral load than controls. Immediate ART initiation and rapid viral load decrease are required, allowing complete clinical recovery.
Collapse
Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | | | - David Nicolás
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Judit Peñafiel
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - Fernando Agüero
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Christian Manzardo
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - María Mar Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - Sonsoles Sánchez-Palomino
- Laboratory of Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain
| | - María A Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - Montserrat Plana
- Laboratory of Retrovirology and Viral Immunopathology, AIDS Research Group, IDIBAPS, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clínic-IDIBAPS, Villarroel, 170, 08036, Barcelona, Spain.
| |
Collapse
|
9
|
Ambrosioni J, Nicolás D, Manzardo C, Agüero F, Blanco JL, Mosquera MM, Peñafiel J, Gatell JM, Marcos MA, Miró JM. Integrase strand-transfer inhibitor polymorphic and accessory resistance substitutions in patients with acute/recent HIV infection. J Antimicrob Chemother 2016; 72:205-209. [PMID: 27624569 DOI: 10.1093/jac/dkw376] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/01/2016] [Accepted: 08/10/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The most recent guidelines suggest using integrase strand-transfer inhibitors (InSTIs) as the preferred antiretroviral regimens for naive HIV-infected individuals. However, resistance to InSTIs is not monitored in many centres at baseline. This study aimed to evaluate the prevalence of InSTI resistance substitutions in newly diagnosed patients with acute/recent HIV infection. METHODS Genotypic drug resistance tests were performed in all consecutive patients prospectively enrolled with a documented infection of <6 months, from 12 May 2015 to 12 May 2016. Sequences were obtained by high-throughput sequencing. RESULTS Five out of 36 consecutive patients (13.89%, 95% CI = 4.67-29.5) with acute/recent HIV infection were detected to have strains carrying InSTI polymorphisms or substitutions conferring low-level resistance to raltegravir and elvitegravir. Four patients had the 157Q polymorphism and one patient had the Q95K substitution. All cases were MSM patients infected with subtype B strains. Viral loads ranged from 2.92 to 6.95 log10 copies/mL. In all cases, the mutational viral load was high. Three patients initiated dolutegravir-based regimens and became undetectable at first viral load control. There were no major viral or epidemiological differences when compared with patients without InSTI substitutions. CONCLUSIONS Although signature InSTI substitutions (such as Y143R/C, N155H or Q148K/R/H) were not detected, polymorphisms and substitutions conferring low-level resistance to raltegravir and elvitegravir were frequently found in a baseline genotypic test. All cases were infected with subtype B, the most frequent in Europe. In the context of primary HIV infection, virological response should be carefully monitored to evaluate the impact of these InSTI polymorphisms and substitutions.
Collapse
Affiliation(s)
- J Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - D Nicolás
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - F Agüero
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J L Blanco
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M M Mosquera
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - J Peñafiel
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M A Marcos
- Laboratory of Virology, Microbiology Service, Hospital Clinic-ISGLOBAL, University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
10
|
Brown KE, Mulders MN, Freymuth F, Santibanez S, Mosquera MM, Cordey S, Beirnes J, Shulga S, Myers R, Featherstone D. Appearance of a novel measles G3 strain in multiple European countries within a two month period, 2010. Euro Surveill 2011. [DOI: 10.2807/ese.16.17.19852-en] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During late 2010, a previously unrecognised strain of measles genotype G3 virus was identified in five different European countries by the World Health Organization Measles and Rubella Laboratory Network. Apart from one, none had a travel history to south-east Asia, the usual source of G3 viruses, although epidemiological links could be established between some of the cases. This case series illustrates the value of genotyping and sequencing in tracking measles infections, and identifying otherwise unrecognised chains of transmission.
Collapse
Affiliation(s)
- K E Brown
- Virus Reference Department, World Health Organization Global Specialised Laboratory for Measles and Rubella, Health Protection Agency - Colindale, London, United Kingdom
| | - M N Mulders
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - F Freymuth
- Centre National de Référence de la Rougeole et des Paramyxoviridae Respiratoires (National Reference Centre for measles and respiratory Paramyxoviridae), Laboratoire de virologie humaine et moléculaire (Laboratory of human and molecular virology), Centre Hospitalier Universitaire de Caen, France
| | - S Santibanez
- National Reference Centre Measles, Mumps, Rubella, Regional Reference Laboratory WHO EURO, Robert Koch Institute, Berlin, Germany
| | - M M Mosquera
- Centro Nacional de Microbiología (National Microbiology Centre), Instituto de Salud Carlos III, Madrid, Spain
| | - S Cordey
- Swiss National Reference Centre for Emerging Viral Diseases, Division of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
| | - J Beirnes
- Viral Exanthemata National Microbiology Laboratory, Winnipeg, Canada
| | - S Shulga
- World Health Organization Regional Reference Laboratory, European Region, Moscow, Russian Federation
| | - R Myers
- Virus Reference Department, World Health Organization Global Specialised Laboratory for Measles and Rubella, Health Protection Agency - Colindale, London, United Kingdom
| | - D Featherstone
- Expanded Programme on Immunization, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
11
|
Brown KE, Mulders MN, Freymuth F, Santibanez S, Mosquera MM, Cordey S, Beirnes J, Shulga S, Myers R, Featherstone D. Appearance of a novel measles G3 strain in multiple European countries within a two month period, 2010. Euro Surveill 2011; 16:19852. [PMID: 21543045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
During late 2010, a previously unrecognised strain of measles genotype G3 virus was identified in five different European countries by the World Health Organization Measles and Rubella Laboratory Network.Apart from one, none had a travel history to south-east Asia, the usual source of G3 viruses, although epidemiological links could be established between some of the cases. This case series illustrates the value of genotyping and sequencing in tracking measles infections, and identifying otherwise unrecognised chains of transmission.
Collapse
Affiliation(s)
- K E Brown
- Virus Reference Department, World Health Organization Global Specialised Laboratory for Measles and Rubella, Health Protection Agency - Colindale, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Perucha M, Ramalle-Gómara E, Lezaun ME, Blanco A, Quiñones C, Blasco M, Gonzalez MA, Cuesta C, Echevarria JE, Mosquera MM, de Ory F. A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006. Euro Surveill 2006; 11:3-4. [DOI: 10.2807/esm.11.10.00649-en] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses
Collapse
Affiliation(s)
- M Perucha
- Department for Epidemiology and Health Prevention. La Rioja Regional Authority, Spain
| | - E Ramalle-Gómara
- Department for Epidemiology and Health Prevention. La Rioja Regional Authority, Spain
| | - M E Lezaun
- Department for Epidemiology and Health Prevention. La Rioja Regional Authority, Spain
| | - A Blanco
- Department for Epidemiology and Health Prevention. La Rioja Regional Authority, Spain
| | - C Quiñones
- Department for Epidemiology and Health Prevention. La Rioja Regional Authority, Spain
| | - M Blasco
- Virology Laboratory. Rioja Health Foundation. La Rioja, Spain
| | - M A Gonzalez
- Department for Epidemiology and Health Prevention. La Rioja Regional Authority, Spain
| | - C Cuesta
- Department for Epidemiology and Health Prevention. La Rioja Regional Authority, Spain
| | - J E Echevarria
- Diagnostic Microbiology Department. National Centre for Microbiology, Carlos III Institute of Public Health, Madrid, Spain
| | - M M Mosquera
- Diagnostic Microbiology Department. National Centre for Microbiology, Carlos III Institute of Public Health, Madrid, Spain
| | - F de Ory
- Diagnostic Microbiology Department. National Centre for Microbiology, Carlos III Institute of Public Health, Madrid, Spain
| |
Collapse
|
13
|
Perucha M, Ramalle-Gómara E, Lezaun ME, Blanco A, Quiñones C, Blasco M, González MA, Cuesta C, Echevarría JE, Mosquera MM, de Ory F. A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006. Euro Surveill 2006; 11:267-70. [PMID: 17130659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
This paper describes a measles outbreak in La Rioja, Spain, which began in December 2005 and mainly affected children under 15 months of age who were not yet immunised with MMR vaccine. The measles cases were detected by the mandatory reporting system, under which laboratories must report every confirmed measles case. Cases were classified in accordance with the National Measles Elimination Plan: suspected and laboratory-confirmed. In the period 14 December 2005 to 19 February 2006, 29 suspected cases of measles were investigated, and 18 were confirmed. The mean incubation period was 13.8 days (range: 9 to 18). Of the 18 confirmed cases, only two were in adults. MMR vaccination was recommended for all household contacts, as well as for children aged 6 to 14 months who attended the daycare centres where the cases had appeared. At these centres, the second dose of MMR was administered ahead of schedule for children under three years of age. It was recommended that the first dose of MMR vaccine be administered ahead of schedule for all children aged 9 to 14 months. During an outbreak of measles, children aged 6 months or older, who have not previously been vaccinated against measles, mumps and rubella, should receive a first dose as soon as possible, and those who have had a first dose should receive a second dose as soon as possible, provided that a minimum of one month has elapsed between the two doses.
Collapse
Affiliation(s)
- M Perucha
- Department for Epidemiology and Health Prevention, La Rioja Regional Authority, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Mosquera MM, Ory FD, Echevarría JE. Measles virus genotype circulation in Spain after implementation of the national measles elimination plan 2001-2003. J Med Virol 2004; 75:137-46. [PMID: 15543577 DOI: 10.1002/jmv.20248] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Molecular characterization of measles virus is important for disease surveillance and for monitoring elimination of the virus throughout the world. Furthermore, knowledge of genotype distribution in as many countries as possible, is useful for tracing the origin of a strain, especially in countries without endemic measles disease, where most cases are imported. Data on genotypes circulating in Spain from 1970 to 1997 showed the prevalence of genotypes C1, C2, and D6, with subsequent replacement of each other. After the establishment of the Spanish Measles Elimination Plan, genotyping with a new retrotranscriptase polymerase chain reaction (RT-PCR) was undertaken directly on 92 specimens, corresponding to 90 patients, which were positive for measles by a different diagnostic RT-PCR. Genotypes B3, D4, D8, A, C2, H1, and D7 were found in different autonomous communities (Madrid, Balearic Islands, Valencia Community, Extremadura, Andalusia, Canary Islands and Murcia) between 2001 and 2003 with none of these genotypes being prevalent. After the introduction of the vaccine in 1978, the incidence of the disease decreased from 150,000 cases in 1977 to 64 in 2002. This could be the reason for the change observed in the pattern of measles genotype circulation, since this pattern was reported in countries at an advanced stage of eradication of measles. This report considers that Spain is on the way to eradicating measles.
Collapse
Affiliation(s)
- María Mar Mosquera
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera de Majadahonda-Pozuelo s/n, 28220 Majadahonda, Madrid, Spain.
| | | | | |
Collapse
|
15
|
Pena MJ, Bolaños M, Pérez MC, Mosquera MM, Trallero G, Lafarga B. [The importance of polymerase chain reaction in the diagnosis of enterovirus infections of the central nervous system in children. Clinico-epidemiologic characteristics]. Enferm Infecc Microbiol Clin 1999; 17:227-30. [PMID: 10396087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND To compare the diagnosis utility of a reverse transcription-polymerase chain reaction (RT-PCR) for detection of enteroviral RNA in cerebrospinal fluid (CSF) in comparison to viral culture for central nervous system infections in pediatric population and to know the clinic epidemiological characteristics of this infection. METHODS From June to December of 1997, 116 CSF samples of children were included in the study. The samples were inoculated in MRC-5 and HEP-2 and the enterovirus RNA was detected with AMPLICOR-Enterovirus (Roche Diagnostic System). The virus were typed by neutralization. RESULTS 36 samples were positive (30 were positive for RT-PCR and 6 for RT-PCR and viral culture). The media time in detect the CPE was 4.8 days. The viruses found were four echovirus 6, one echovirus 30 and one echovirus 7. Fifteen children were under 6 months (93.3% under two months) and 21 children over 6 months with a media age of 81 months (range, 38-160 months). In over 6 months old children, the most frequent clinical presentation was meningitis aseptic syndrome with pleocytosis and in under 6 months old ones was fever and only 60% of these children had pleocytosis. The evolution was good in all the cases. CONCLUSIONS AMPLICOR-Enterovirus is a sensitive method for the diagnosis of enteroviral meningitis. The clinical manifestations are different with the age and due to the absence of neurological symptoms and pleocytosis in the patients under two months, we think that it is necessary to study the presence of enterovirus with genetic amplification methods in this population of patients.
Collapse
Affiliation(s)
- M J Pena
- Servicio de Microbiología, Hospital Nuestra Señora de Pino, Las Palmas de Gran Canaria.
| | | | | | | | | | | |
Collapse
|
16
|
Pena MJ, Mosquera MM, Pérez MC, Rodríguez San Román JL, Martín JM, Avalos O, Lafarga B. [Prevalence of hepatitis C virus genotypes: epidemiology and histologic characteristics]. Enferm Infecc Microbiol Clin 1998; 16:456-60. [PMID: 9918991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To analyse the prevalence of HCV genotypes among patients from Gran Canaria and the relation with the routes of viral transmission, date of primoinfection and severity of hepatic lesion. PATIENTS AND METHODS 179 patients were studied. In 61 patients the date of exposure was determinate. Liver biopsies were obtained in 139 patients. Genotypes were determinate by reverse hybridisation using InnoLiPA genotyping kit (Innogenetics). RESULTS The distribution of genotypes was: 1b, 114 (63.7%), 1a, 30 (16.7%); 1, 17 (9.5%); 3a, 7 (3.9%); 4c/4d, 6 (3.3%); 2, 1 (0.5%); 2a/2c, 2 (1.1%), 3, 1 (0.5%) and 4f, 1 (0.5%). We did not find any case of coinfection with a second genotype. In univariable analysis, we found statistically differences in sex (78.9% of women infected with genotype 1b compared with 55.1% of men, p < 0.01 and 31.6% of men infected with 1a, 3a and 4c/4d compared with 15.7% of women, p < 0.01) and age (median age in genotype 1b 45 +/- 12 years vs 36 +/- 9 years in the other genotypes, p < 0.01). HCV subtypes 1a and 3a were predominant in patients IVDA (47.6% and 23.85% respectively) and 1b in blood transfusion receptors (71.2%) (p < 0.01). In 40.2% of the patients, the sources of infection were unknown. In the multivariable logistical regression analysis we found the only factor influencing the genotypes distribution was the transmission mechanism (p < 0.001) and sex and age are relationated with the transmission mode. The media infection duration in patients infected with 1b was 22 +/- 11 years vs 9 +/- 6 years in the other genotypes. We found differences in the liver histologic findings and the age of the patient, but not in the different genotypes. CONCLUSIONS Our study reflects the higher frequency of HCV subtype 1b in our area and a different prevalence of genotypes in relation to mode of transmission. Our results suggest that in our media the liver damage seems to be directly influenced by the age of the patient, but not influenced by HCV genotype.
Collapse
Affiliation(s)
- M J Pena
- Servicio de Microbiología, Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria
| | | | | | | | | | | | | |
Collapse
|
17
|
Campos-Herrero MI, Pena MJ, Mosquera MM, Conde A, Vitoria MA, López L. [Disseminated infection by Mycobacterium genavense]. Enferm Infecc Microbiol Clin 1998; 16:435-7. [PMID: 9887634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|