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Introduction In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic. Methods Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin. Results Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended. Conclusions The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.

Fun da men tos: Para un buen de sa rro llo de los pro gra mas de va cu na ción es pri mor dial co nocer la co ber tu ra de va cu na - ción. En las Islas Ba lea res la co ber tu ra no ti fi ca da era muy in fe - rior a la del res to de Espa ña. El ob jetivo de este tra ba jo es la es - ti ma ción de la co bertura de las va cunas in clui das en el ca len da - rio re co men da do has ta los 18 me ses de edad (4 do sis de po lio oral, té tanos y dif te ria; 3 de tos fe ri na; 1 de sa ram pión, ru beo la y pa rotiditis). Mé to dos: Estu dio des crip ti vo, trans ver sal, de base po bla - cio nal. Se cal cu la ron los es ti ma do res pun tua les de dis tri bu ción de fre cuen cias y los in ter va los de con fian za al 95% (IC95%) co rres pon dien tes, so bre una mues tra de la po bla ción re si den te en Ba lea res de dos años de edad (na ci da en 1995), se lec cio na da por mues treo alea to rio por con glo me ra dos en una sola eta pa a par tir de las sec cio nes cen sa les. Se con sul tan los re gis tros de va cu nas de Sa ni dad y de los cen tros de sa lud del Insa lud, se pide te le fó ni ca men te a las fa mi lias los da tos del do cu men to de va cu na ción y a los pe dia tras pri va dos los de la his to ria clí nica. Re sul ta dos: La mues tra in cluía 606 ni ños. Pudo ob te ner se la in for ma ción com ple ta de 532. Se con si guió la in for ma ción com ple ta de 377 ca sos (62%) a par tir de los re gis tros del sec tor pú bli co. La co bertura más baja fue la de la va cu na an ti dif té ri ca, 518 ni ños com plen ta men te va cu na dos, el 96,8% (IC95% = 94,8 ? 98,1) y la más alta la de la va cu na an ti per tus sis, 537 ni - ños, el 98,9% (IC95% = 97,5 ? 99,5). Conclusiones: En las Islas Ba lea res exis te una bue na co - ber tu ra de la va cu na ción, si mi lar a lo que se vie ne es ti man do en Espa ña en su to ta li dad. Se cum ple el ob je ti vo in clui do en el Plan de Erra di ca ción de la Po lio. La in for ma ción re co gi da des - de el sec tor pú bli co es es casa.

ResumenSe describe la investigación de un brote de gastroenteritis por norovirus asociado al consumo de ostras. Se encuestaron 346 expuestos (266 afectados). Solamente se enviaron 14 muestras de heces de pacientes al Centro Nacional de Microbiología. Se mandaron ostras recogidas en el lugar de producción al Centro Nacional de Alimentación. Las ostras cumplían los parámetros microbiológicos de calidad aplicables antes de la comercialización, que no incluyen investigación de virus. El análisis epidemiológico asoció la aparición de la enfermedad al consumo de ostras (odds ratio [OR]=60,4; intervalo de confianza del 95% [IC95%]: 26,2-139,3) y de navajas (OR=3,13; IC95%: 1,4-6,9). Los análisis microbiológicos identificaron norovirus en los afectados, pero no en las ostras que habían estado sometidas a un tiempo mayor de depuración que las consumidas. Es necesario un control riguroso de los alimentos de especial riesgo para la transmisión de norovirus y disponer de recursos de laboratorio para investigar brotes alimentarios por norovirus.AbstractWe describe investigation into an outbreak of norovirus gastroenteritis associated with oyster consumption. A survey was conducted in 346 exposed persons, 266 of whom were cases. Only 14 feces samples from patients were sent to the National Microbiology Laboratory. Oysters collected at the production site were sent to the National Food Center. The oysters met the microbiological quality standard required before sale, which did not include virus investigation. Epidemiological analysis showed an association between gastroenteritis and consumption of oysters (OR=60.4; 95% CI: 26.2-139.3) and razor shells (OR=3.13; 95% CI: 1.4-6.9). Microbiological analysis confirmed norovirus in affected individuals but not in the oysters that had been tested after a longer purification period than those consumed. Food with a special risk of norovirus transmission should be strictly monitored. Investigators should dispose of the necessary laboratory resources to study food-borne norovirus outbreaks.

The tuberculosis surveillance system in the Balearic Islands was assessed from 2005 to 2007. Applying the capture-recapture method the completeness of this system was evaluated to be 58.4%. When a new electronic recorded data was included in Primary Health Care, up to 66.5% was obtained. This new source of data increased the detected cases of pulmonary tuberculosis from 572 to 681. As a result, the estimated annual incidence rate increases from 18.9 cases/10(5) to 22.6 cases/10(5) [95% CI, 20.9-24.3], similar to figures issued by WHO.

In a background of very low incidence of hepatitis A HA in the last decade (annual average of 1.8 cases per 100,000 inhabitants) we describe an outbreak of HA which evolved in Mallorca between May and August 2010, whose main focus was a nursery school where more cases were parents and other young relatives of the children of the institution. Thirty-four cases were defined as outbreak cases. Ten were children of the nursery or their siblings and 22 adults (3 staff members of the nursery and 19 relatives; median age 33 years). The first detected cases were children of the same class. There were 2 adults with haematological complications, though not severe. All children, nursery staff members, parents, and siblings of the cases of the first affected class were immediately offered HA vaccination, but only 43.3% eligible individuals accepted it. None of the cases had been vaccinated. The outbreak spread mostly from asymptomatic children to young adults, showing the changes in HA pattern. That is of great concern as the risk of severe illness rises with age. This incident shows the need to implement new HA vaccination policies in outbreak control. This was later carried out.

In order for vaccination programs to be carried out properly, it is essential for the vaccination coverage to be known. On the Balearic Islands, the reported coverage was much less than for the rest of Spain. The objective of this study is that of estimating the coverage of the vaccinations included on the recommended schedule up to 18 months of age (4 doses of oral polio, tetanus and diphtheria; 3 doses of whooping cough; 1 dose of measles, rubella and mumps).A descriptive, cross-sectional study of the population base. The ideal-time frequency distribution estimators and the corresponding confidence intervals were calculated at 95% (CI95%) for a sample of the resident two-year-old (born in 1995) Balearic Island population selected by means of a single-stage conglomerate random sampling based on census sections. The National Public Health System and National Health Institute vaccination records were reviewed, the data from the vaccination document having been requested from the families and the clinical record from the private pediatricians by telephone.The sample included 606 children, it having been possible to obtain full information on 532 children. Full information was obtained on 377 cases (62%) from the public health sector records. The least degree of coverage was found for the diphtheria vaccine, 518 children having been fully vaccinated, 96.8% (CI95% = 94.8-98.1), the highest degree of coverage having been found for the whooping cough vaccine, 537 children, 98.9% (CI95% = 97.5-99.5).Good vaccination coverage was found to exist on the Balearic Islands, being similar to what has been being estimated for Spain as a whole. The objective included within the Polio Eradication Plan is accomplished, very little information being gathered from the public sector.

[ES] Estudio descriptivo de los casos de tuberculosis detectados por el Sistema de Vigilancia Epidemiológicaen Baleares, en el trienio de 2005 a 2007. El objetivo fue caracterizar los casos infradeclarados en términos sociodemográficos y de su contacto con la atención primaria de salud. Globalmente, la infra declaraciónde la tuberculosis se sitúa en torno al 20%. Las características que resultan significativas en el análisis multivariado son la marginalidad social (alcoholismo, usuarios de drogas por vía parenteral o indigencia) (odds ratio ajustada [ORa]:2,6 [1,2-5,3]), el contacto con la atención primaria (ORa:3,2 [1,4-7,1]) y la tuberculosis extrapulmonar (ORa:5,5 [3,2-9,6]). Se recomienda reforzar la notificación de los especialistas hospitalarios mediante la adecuación informática de la historia clínica hospitalaria, y se observa quela información obtenida desde la informatización de la historia en atención primaria resulta de utilidad para mejorar la vigilancia epidemiológica de la tuberculosis. [EN] We performed a descriptive study of tuberculosis cases detected by the Epidemiological Surveillance System in the Balearic Islands in the triennium 2005-2007. Our goal was to characterize underreported cases in sociodemographic terms and their contact with primary care. Overall, underreporting of tuberculosis was approximately 20%. Significant factors in multivariate analysis were social marginality (consisting of alcoholism, intravenous drug use or indigence) (aOR: 2.6 [1.2 to 5.3]), contact with primary care (aOR: 3.2 [1.4 to 7.1]), and extrapulmonary tuberculosis (aOR: 5.5[3.2-9.6]). We recommend strengthening notification by hospital specialists through the use of hospital electronic records. Our findings show that the information obtained from the primary care computerized history is helpful in improving the epidemiological surveillance of tuberculosis. Sí